Care Manager II - Case Management

CHRISTUS Health•Beaumont, TX

9d•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 identifies, initiates, and 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 both 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 goals, performance standards, policies, procedures, and regulatory requirements. The position coordinates case management functions with hospital departments and external organizations, facilitates efficient and cost-effective care progression, advocates for patients, monitors length of stay, and works with the interdisciplinary team to address delays and barriers. It assesses patient and family needs and support systems, develops individualized care plans with physicians, coordinates appropriate post-acute services and resources, and ensures the plan is communicated and documented. The Care Manager provides education and support, promotes appropriate resource use, participates in quality and performance improvement activities and care progression rounds, and escalates cases when appropriate. The role may include special projects and precepting or orienting new associates. The work involves moving around all areas of the hospital for most of the workday, with the remainder spent in an office, in a general office and hospital environment. Schedule is 8:00 AM to 5:00 PM, Monday through Friday.

Requirements

Graduate of an accredited school of nursing, with a BSN preferred, or a Master’s Degree in Social Work (MSW); alternatively, demonstrated success in the CHRISTUS Care Manager I position for at least five years, in addition to the required experience, may satisfy the education requirement.
Two or more years of clinical experience; one year in an acute care setting is preferred.
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 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 the hospital to all areas for the majority of the workday.

Nice To Haves

BSN preferred.
One year of experience in an acute care setting preferred.
Certification in Case Management preferred.
BLS preferred.

Responsibilities

Coordinate the integration of case management into patient care and discharge planning with hospital departments, external organizations, agencies, and healthcare facilities.
Facilitate patient care progression throughout the continuum of care in an efficient and cost-effective manner.
Advocate for patients regarding treatment decisions, end-of-life issues, care planning, resource coordination, and transitions to the appropriate next level of care.
Monitor patient length of stay in relation to the geometric mean and collaborate with interdisciplinary team members to remove barriers and expedite discharge.
Implement and monitor the patient’s plan of care to ensure services are effective and appropriate.
Identify and promptly escalate barriers to diagnostic or treatment progress, quality, or risk; proactively resolve delays and obstacles to discharge.
Use conflict-resolution skills and collaborate with medical, nursing, and ancillary staff to support efficient care in the appropriate setting.
Interview patients and families about social, emotional, and financial factors affecting health and develop comprehensive discharge assessments and care plans.
Assess discharge planning and continuing-care needs, and independently recommend post-acute care levels and options, referrals, and community resources.
Initiate discharge planning at admission and make post-hospital service referrals based on assessments and collaboration with physicians, the care team, and payors as indicated.
Negotiate for and coordinate resources with payors, agencies, and vendors on behalf of patients.
Ensure care-plan information is communicated to patients, families, and healthcare team members and documented to support continuity of care.
Provide culturally sensitive interventions that account for patients’ religious, developmental, health-literacy, and educational backgrounds.
Assess patients’ formal and informal support systems, benefits, and available community resources.
Meet directly with patients and families to assess needs and develop individualized care plans with physicians; maintain consensus among the patient or family, physician, and payor.
Provide education, information, direction, and support related to patients’ goals of care.
Promote respect for patient dignity and rights while adhering to organizational and nursing safety standards and practices.
Collaborate with physicians and healthcare professionals to promote appropriate use of medical center resources.
Help patients and families access resources within the medical center and community.
Participate in clinical performance improvement activities involving length of stay, resource utilization, avoidable days, cost per case, and readmissions.
Measure intervention effectiveness through communication with post-acute care providers, patients, and caregivers.
Participate in multidisciplinary and patient care progression rounds; escalate cases to Physician Advisors and/or the CM Director as appropriate and per policy.
Document in the medical record according to regulatory and departmental guidelines.
Meet mandatory and continuing education and skills competency requirements; assume responsibility for professional growth and development.
May assist with special projects and serve as a preceptor or orienter to new associates.