RN Case Manager I

Job Description

Job Description

Description : Job Summary :

Create accountability for designated patient groups / staff teams providing oversight and clinical guidance to RN Case Manager I positions and assisting social worker employees within clinical aspect of discharge planning as needed. This position as RN nurse mentor for nursing staff within the department; precepts new team members as requested by leadership and functions as team lead. This positions functions under the guidelines of patient centric nursing process utilizing UMC nursing model, actively participating in the “Magnet” journey related to nursing practice and behavior works to directly manage length of stay (LOS-targets for assigned populations) and assure efficient utilization of resources through the prevention of avoidable days (data capture, analysis, reporting and recommendation for change) and unplanned readmissions. Acts. Individuals within RN Case Manager II position are strategic, innovative and utilize critical-thinking to create optimal patient / staff / customer outcomes while supporting organizational mission, vision and values.

Knowledge, Skills & Abilities

Must demonstrate excellent interpersonal communication and negotiation skills with leadership capability. Understanding of discharge planning, utilization management, case management, performance improvement, managed care reimbursement, data collection, analysis and report development or interpretation. Understanding of pre-acute, acute and post-acute venues of care and post-hospitalization community resources. Drives achievement of patient “right care, right time, right place” practice. Ability to work independently and exercise sound clinical judgement with all decision-making. Ability to demonstrate high levels of emotional intelligence in fast-paced, high-stress environment. Ability to understand and perform all duties / responsibilities within the RN-Case Manager I role successfully. Develops and delivers successful educational sessions to co-workers. Manages successful implementation of case management and nursing models. Is viewed by peers as a departmental leader.

Responsibilities

• Oversees the management of assigned patient populations across the continuum.
• Serves as a resource to the multidisciplinary / multiprofessional team to manage appropriate and safe patient care transition..
• Works with departmental / physician / nursing leadership and the healthcare team for defined patient populations assisting to implement clinical pathways as appropriate.
• Drives patient satisfaction related to discharge planning and assures all patients are assessed for timely, appropriate and safe discharge planning.
• Serves as the primary information resource for case management staff, payors, and physicians, other healthcare team members, customers and regulatory bodies. (skill areas include : regulatory requirements, pathway implementation / i, ethics / healthcare law, clinical skills, etc.).
• Mitigates patient safety risk and risk of discharge planning failures.
• Educates others on case management responsibilities.
• Readily accepts responsibility for actions / discharge planning / appropriate utilization provided by assigned team.
• Assumes delegated activities from the manager / director / chief officer as requested.
• Addresses / resolves system problems impeding diagnostic or treatment progress.
• Proactively mitigates risk to patients with special focus on clinical discharge planning using the nursing process of assessment, intervention, implementation, and evaluation
• Seeks consultation from appropriate disciplines / departments / leaders as required to expedite care and facilitate safe discharge.
• Utilizes critical-thinking and demonstrates innovative thought.
• Completes utilization management and quality screening for assigned patients as needed.
• Assures compliance related to utilization review; CMS conditions of participation and regulations associated with external entities.
• Identifies at-risk populations and establishes or identifies intervention to reduce risk and implements reporting procedures.
• Takes actions to achieve continuous improvement and understands continuous improvement methodology...
• Ensures that all elements critical to the discharge plan have been communicated to the patient / family and members of healthcare team.
• Assures appropriate documentation is completed on all patient groups timely, accurately and concisely.
• Responsible for coordinating seamless discharges
• Drives initiatives to reduce excess days
• Works to improve staff satisfaction through team building
• Recognizes the importance of a dyad model utilizing social worker(s) as needed related to social work expertise
• Is customer driven and focused, recognizing customers include but are not all inclusive of : co-workers; providers; payers; nurses and ancillary staff in addition to outside entities accepting patient referrals or working to provide supplies / equipment.
• Obtains necessary CEUs to maintain an active RN license.
• The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands

Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, occasional handling or working with potentially dangerous equipment, occasional exposure to bio-hazardous conditions such as risk of radiation exposure, blood borne pathogens, fumes or airborne particles, and / or toxic or caustic chemicals which mandate attention to safety considerations, occasional working hours significantly beyond regularly scheduled hours, occasional work produced subject to precise measures of quantity and quality, occasional bending, occasional lifting and carrying up to 25 pounds, occasional climbing, occasional crawling, occasional crouching / stooping, occasional driving, occasional kneeling, occasional pushing / pulling, occasional reaching, occasional sitting, occasional standing, occasional twisting, and frequent walking. (occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)

Requirements :

Education & Experience

Licensed RN with two (2) years of RN experience in an acute care environment. Utilization management or case management / coordinated care experience preferred.

Certifications, Licenses or Registration required :

Valid RN Mississippi state license or compact-state license or eligible for transfer of RN license to state of Mississippi. Accredited Case Manager Certification (ACMC) or Certified Case Manager (CCM) or agreeable to achieve within 24 months of employment.