Care Manager II - Case Management

CHRISTUS Health•San Antonio, TX

10d•Onsite

About The Position

The Care Manager II works collaboratively with patients and families, physicians, and multidisciplinary team members to support patient progression through the continuum of care and develop a plan of care from admission through discharge. The role manages patient flow and throughput to promote continuity of care, safe transitions, patient satisfaction and safety, and length-of-stay management. It provides comprehensive assessment, planning, implementation, and evaluation of individual patient needs, with responsibility for care coordination and discharge planning. The Care Manager coordinates team efforts, responds to patient and family needs, and identifies and resolves barriers to effective care while adhering to organizational and departmental standards, policies, procedures, goals, and regulatory requirements. The position assesses patients’ clinical and social needs, develops individualized care plans with patients, families, and physicians, and recommends appropriate post-acute care and community resources. It advocates for patients, coordinates with payors and service providers, monitors care plans and length of stay, facilitates discharge, documents in the medical record, and participates in performance improvement and multidisciplinary rounds. The Care Manager may assist with special projects and serve as a preceptor or orienter to new associates.

Requirements

Graduate of an accredited school of nursing (BSN preferred), or a Master’s Degree in Social Work (MSW); alternatively, at least five years of demonstrated success in the CHRISTUS Care Manager I position, in addition to the required experience, may substitute for the education requirement.
RN or LMSW license in the state of employment required for new hires; LBSW is accepted for associates with five or more years of demonstrated success and experience as a CHRISTUS Care Manager I.
Excellent verbal and written communication skills and ability to interact with diverse populations.
Critical and analytical thinking skills.
Demonstrated clinical competency.
Ability to multitask and function in a stressful, fast-paced environment.
Working knowledge of discharge planning, utilization management, case management, performance improvement, and managed-care reimbursement.
Understanding of pre-acute and post-acute levels of care and community resources.
Ability to work independently and exercise sound judgment when interacting with physicians, payors, patients, and families.
Understanding of internal and external resources and knowledge of available community resources.
Ability to move around all areas of the hospital for most of the workday, with the remainder of the day in an office setting.

Nice To Haves

BSN preferred.
Two or more years of clinical experience, with one year in an acute-care setting preferred.
Certification in Case Management preferred.
BLS preferred.

Responsibilities

Meet expectations for applicable OneCHRISTUS competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Integrate case management functions into patient care and discharge planning in collaboration with hospital departments, external organizations, agencies, and healthcare facilities.
Coordinate and facilitate efficient, cost-effective patient progression across the continuum of care.
Serve as a resource and patient advocate regarding treatment decisions, end-of-life issues, and access to resources.
Monitor length of stay relative to geometric mean length of stay and collaborate with interdisciplinary team members to address barriers and expedite discharge.
Implement and monitor the patient’s plan of care for effectiveness and appropriateness of services.
Identify and escalate barriers to diagnostic or treatment progress and quality or risk concerns in a timely manner.
Proactively identify and resolve delays and obstacles to discharge, using advanced conflict resolution skills as needed.
Collaborate with medical, nursing, and ancillary staff to support efficient delivery of care in the appropriate setting.
Interview patients and families about social, emotional, and financial factors affecting health to develop discharge assessments and care plans.
Assess discharge planning and continuing-care needs; recommend post-acute care options and resources, including rehabilitation, skilled nursing, psychiatric or substance-abuse services, dialysis, abuse-related resources, home health or hospice, legal resources, advance directives, community resources, funding options, durable medical equipment, and social-determinants-of-health support.
Begin discharge planning at admission and make post-hospital service referrals based on assessment and input from physicians, the care team, and payors as indicated.
Negotiate for and coordinate resources with payors, agencies, and vendors on behalf of patients.
Communicate plan-of-care elements to patients, families, and healthcare team members and document them as needed to support continuity of care.
Provide culturally sensitive interventions responsive to patients’ religious, developmental, health-literacy, and educational backgrounds.
Assess formal and informal support systems, benefits, and available community resources.
Meet with patients and families to assess needs and develop individualized care plans with the physician, maintaining consensus among the patient or family, physician, and payor.
Provide education, information, direction, and support related to patients’ goals of care.
Coordinate treatment and transitions to the appropriate next level of care while advocating for the patient.
Respect patients’ dignity and rights and adhere to organizational and nursing-profession safety standards and practices.
Collaborate with physicians and other healthcare professionals to promote appropriate use of medical-center resources.
Help patients and families access needed resources within the medical center and community.
Participate in clinical performance-improvement activities concerning length of stay, resource utilization, avoidable days, cost per case, and readmissions.
Evaluate intervention effectiveness through communication with post-acute providers, patients, and caregivers.
Meet mandatory and continuing education and skills-competency requirements and support professional growth and development.
Participate in multidisciplinary and patient-care-progression rounds.
Escalate cases to Physician Advisors and/or the CM Director as appropriate and according to policy.
Document in the medical record in accordance with regulatory and departmental guidelines.
Assist with special projects as requested and may serve as a preceptor or orienter to new associates.
Maintain professional growth and development.