CASE MANAGER RN

General Purpose of Job:

Effectively manages and coordinates the patient's plan of care across the continuum. Works collaboratively with the interdisciplinary team enhancing the quality of patient clinical outcomes and patient satisfaction with efficient and effective utilization of resources.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis. Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

• Core Components of Discharge Planning
• Discharge Planning Concepts - establishing quality measures and boundaries of practice in accordance with case management process, tools, standards, models, goals objectives and performance improvement concepts.
• Discharge Planning Principles and Strategies- maintaining standards of professional practice of confidentiality, conflict resolution strategies, negotiation skills, ethics and advocacy.
• Psychological and Support Systems - implements and integrates culturally sensitive strategies including clients' needs surrounding spiritually, wellness and illness management, behavioral and psychiatric care, psychosocial aspects of illness complementary medicine family dynamics as well as working knowledge of caring for victims of abuse.
• Healthcare Management and Delivery - ensures care management occurs for assigned caseload across the continuum of Care. Develops collaborative relationships with providers.
• Healthcare Reimbursement - participates in Revenue cycle management by incorporating discharge planning principles by cost containment principles, healthcare insurance principles and cost containment practices.
• Vocational Concepts and Strategies - address the needs of assigned patient caseload as the patient moves along the healthcare continuum towards the lowest level of care including disability compensation, vocational and financial aspects of chronic illness and disability and work adjustments.
• Completes letters of medical necessity as needed for patient discharge.
• Utilization Management>>>
• As a part of service delivery, performs an initial comprehensive assessment of the patient including review of the medical record to determine discharge needs and utilization management.
• Facilitating timely discharges to the appropriate level of care.
• Concurrent Clinical Management - Care Coordination
• Coordinates care within the framework of the multi-disciplinary plan of care to facilitate patient's progress along the healthcare continuum outcomes, which includes discharge. Acts as a clinical resource for the multi-disciplinary team. Monitors resource utilization in according to the plan of care, clinical pathway and patient diagnosis.
• Assertive care coordination among the interdisciplinary team
• Coordinating care using Pathways or Plan of Care and participating in the ongoing development and revision of Pathways and Plan of Care.
• Identifying and preventing common patient complications and works to prevent.
• Performs and documents all aspects of Transitional Planning including:
• Assessment - collects and analyzes in-depth information of the patients current health status and needs from all relevant sources
• Planning - plans a client centered, need based transitional plan that is realistic, patient oriented and time specific.
• Implementation - enacts transitional plan that effectively moves the patient along the care continuum. Effectively works with the community to identify and allocate post discharge needs.
• Coordination - aggregates and secures all resources to effectively accomplish the goals set forth in the initial Discharge Planning assessment
• Monitoring - utilizes all relevant resources to gather sufficient information regarding the effectiveness of the plan
• Evaluation - seeks feedback from all relevant sources regarding the effectiveness of the Discharge Plan.
• Outcomes - evaluates outcomes related to the Case coordination process including LOS,
• Readmission reports, patient satisfaction and financial variances related to case coordination participation in the patients care. Reports pertinent variances Screen all admissions
• Gatekeeping for organization
• Apply clinical screening criteria
• Deliver accurate clinical picture to 3rd party reimbursement
• Past admission status review for readmitted patients
• Assist in appealing admissions that payers deny.
• Collaborate with Discharge Planning and Complex Care Specialist to assist with appropriate discharge plan.
• The above duties and responsibilities are intended to describe the general nature and level of the work being performed by caregivers assigned to this job. They are not an exhaustive list of all duties and responsibilities associated with it.
• Complete precertification's/recertification's as necessary.
• Understand how to confirm the insurance coverage for each potential patient, understands the approval criteria/process for each payer, and assures that applicable approvals are obtained and documented appropriately