RN Case Manager

Job Description :

VALLEY MEDICAL CENTER

Job Description

Case Management

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE : RN Case Manager

JOB OVERVIEW : The RN Case Manager facilitates discharge coordination, effective patient throughput in the inpatient setting, and continuity of care for specified populations in the acute care setting. This includes collaboration with patients, surrogates, families, physicians, nurses, and other members of the health care team to address patient needs through effective coordination of services. The RN Case Manager evaluates clinical requirements, synthesizing patient goals of care, treatment preferences, and available resources in the development of a discharge plan that accounts for continuum of care needs and is commensurate with the patient's right to self-determination.

AREA OF ASSIGNMENT : Case Management

HOURS OFWORK : Typically, day shift Monday - Friday with weekend and holiday rotation.

RESPONSIBLE TO : Manager, Case Management

PREREQUISITES :

Current license as a registered nurse in the State of Washington.

Minimum five years recent clinical experience as an RN working in an acute care setting required; 3 years of experience as a case manager preferred.

Bachelor's degree preferred.

Certification in Case Management preferred.

Ability to communicate fluently in English, both verbally and in writing.

Ability to type fluently and quickly; write legibly, spell correctly, and use accepted grammar.

QUALIFICATIONS :

Ability to assess the clinical requirements of care in the medical setting; and to create, implement, and evaluate the effectiveness of care plans which address identified needs.

Ability to meet and demonstrate VMC's mission, vision, and values, and abide by the VMC Caregiver Commitment.

Effective communication skills, including group facilitation and conflict management skills.

Ability to work in a collaborative team setting with peers.

Interpersonal skills necessary to interact with the multidisciplinary team of care providers, to coordinate care for patients and families.

Demonstrates sensitivity and compassion in the coordination of care requirements for all patients and families from a variety of ethnic, cultural, social, and economic backgrounds and with varied medical and developmental needs.

Knowledge of community resources and how to access them effectively and efficiently.

Knowledge of the healthcare financial environment, reimbursement methodologies, and length of stay management.

Ability to work independently without close supervision; while managing multiple demands, prioritizing and producing accurate work, while, meeting outcome expectations and deadlines.

Ability to function in multiple and varied settings throughout the facility.

Neat and well-groomed appearance consistent with VMC dress code policy.

Experienced navigator of basic electronic applications including Outlook, Office, and calendar management.

Experienced in use of electronic health record (EHR).

UNIQUE PHYSICAL / MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS :

See Generic Job Description for Clinical Partner.

PERFORMANCE RESPONSIBILITIES :

A. Generic Job Functions : See Generic Job Description for Clinical Partner.

B. Essential Responsibilities and Competencies

Collaborate with partners on the care team including social work and discharge coordinators by facilitating timely medical case reviews, addressing priority of patient care needs based on case load, and allocating distribution of patient case load based on medical complexity of care.

Assess, plan, and facilitate discharges and transitions of care for the medically complex patient population including the following :

Review past and present medical records to determine history, admitting diagnosis or procedure, and plan of care compared to previous history and care needs.

Collaborate with the patient or surrogate in the gathering of pertinent information about the patient's psychosocial, functional and financial situation to identify needs or barriers to care.

Communicate with the multidisciplinary team (physicians, nurses, therapists, social workers, chaplain, etc.) as needed to complete assessment.

Establish a discharge plan based upon individual patient needs, patient preferences, and existing or proposed treatment options in order to support and promote desired clinical, outcomes in a timely manner.

Provide relevant education and information regarding resources to patient / surrogate to facilitate informed decision making and active participation in the plan for transfer / discharge.

Identify, address, and implement goals of care and treatment preferences with patient / surrogate regarding available options, empowering the ability to make choices in their best interest.

Identify benefits and coordinate resources based on patient's needs and preferences.

Work with insurance companies and / or public health benefit programs (DSHS, Medicare, Medicaid, County, State) to optimize benefits available to the patient.

Initiate timely family conferences or multidisciplinary case conferences with the treatment team for complex transition discharges.

Respond to nurse, physician, and admission review screens in a timely manner.

Manage readmission reviews including root cause analysis; facilitate patient engagement as an active participant of the treatment team by addressing goals of care, treatment preferences, and strategies for successful transitions to lower levels of care.

Engage in post-discharge follow up to manage successful transitions in care.

Independently complete assessment and plan interventions sensitive to the patient's cultural, social, physical, mental and economic status and developmental state. Demonstrate sensitivity to the patient's / caregiver's beliefs and values and incorporate that understanding into the discharge plan.

Manage and prioritize work based on clinical needs, length of stay, required complexity of interventions, and acuity of care.

Document all assessments, plans, and interventions in the medical record with clarity and conciseness unique to each specific patient or family interaction and in accordance with professional, legal, regulatory and departmental standards in a timely manner.

Complete and / or review admission review assessments to identify potentially high-risk patients who may have an adverse health consequence without a case management order.

Communicate effectively with other members of the multidisciplinary care team using appropriate interpersonal skills, group facilitation and conflict management skills as appropriate.

Maintain current knowledge of case management, utilization management, and discharge planning resources.

Work collaboratively with the Utilization Management team and Patient Financial Counselors.

Refer quality, infection control, and risk management issues to the appropriate individual or department.

Perform other duties as assigned, including orientation and training of new staff members.

Serve as committee member or liaison to community partners per request of management.

JC- 4103

Revised : 5 / 20

Grade : SEIURNCASE

FLSA : NE

CC : 8715

Job Qualifications : PREREQUISITES :

Current license as a registered nurse in the State of Washington.

Minimum five years recent clinical experience as an RN working in an acute care setting required; 3 years of experience as a case manager preferred.

Bachelor's degree preferred.

Certification in Case Management preferred.

Ability to communicate fluently in English, both verbally and in writing.

Ability to type fluently and quickly; write legibly, spell correctly, and use accepted grammar.

QUALIFICATIONS :

Ability to assess the clinical requirements of care in the medical setting; and to create, implement, and evaluate the effectiveness of care plans which address identified needs.

Ability to meet and demonstrate VMC's mission, vision, and values, and abide by the VMC Caregiver Commitment.

Effective communication skills, including group facilitation and conflict management skills.

Ability to work in a collaborative team setting with peers.

Interpersonal skills necessary to interact with the multidisciplinary team of care providers, to coordinate care for patients and families.

Demonstrates sensitivity and compassion in the coordination of care requirements for all patients and families from a variety of ethnic, cultural, social, and economic backgrounds and with varied medical and developmental needs.

Knowledge of community resources and how to access them effectively and efficiently.

Knowledge of the healthcare financial environment, reimbursement methodologies, and length of stay management.

Ability to work independently without close supervision; while managing multiple demands, prioritizing and producing accurate work, while, meeting outcome expectations and deadlines.

Ability to function in multiple and varied settings throughout the facility.

Neat and well-groomed appearance consistent with VMC dress code policy.

Experienced navigator of basic electronic applications including Outlook, Office, and calendar management.

Experienced in use of electronic health record (EHR).