Case Management Coordinator

University Hospital, Newark NJ•Newark, NJ

About The Position

The primary purpose of the Case Management Coordinator position is to coordinate the patient’s progress through the system. He/she collaborates with physicians and clinical staff to ensure resource utilization is appropriate to the patient’s clinical and psychosocial needs and that it remains within covered benefits. The Case Management Coordinator seeks creative solutions to process and system issues, which create a barrier to the delivery of medically appropriate, cost-effective care. He/she is responsible to ensure compliance with regulatory standards related to level of care determinations, utilization and discharge planning. The Case Management Coordinator performs transitions of care and discharge planning, and supports the mission of University Hospital.

Requirements

Registered Nurse with a license to practice in the State of New Jersey required.
Bachelor’s Degree in Nursing or a health care related fieldrequired.
Minimum of four (4) years of acute care hospital clinical experience required.
Recent experience in case management, home health, utilization review, and or unit clinical specialty required.
Basic computer skills required.
Ability to work effectively and collaboratively with interdisciplinary teams.
Demonstrates resourcefulness, effective written and oral communication, negotiating and analytical skills.
Additional related experience may be substituted for the Bachelor’s degree on a year-for-year basis.
Must be available to rotate on weekends as part of a team.
BLS (CPR) required.

Nice To Haves

Master’s degree in Nursing or Health Care related field preferred.
Case management certification from either CCM, ACMA or RN-BC preferred.

Responsibilities

Service provided is patient centered; actively contributes to creating a friendly, welcoming and safe environment; communicates clearly; responds to complaints and concerns by resolving issues immediately; organizes work processes to accommodate customer needs; meets or exceeds customer expectations; acts as a role model for Service Excellence; maintains professional composure; works effectively with team to ensure customer service scores meet/exceed targets; demonstrates respect for patient rights.
Facilitates the development and implementation of a comprehensive, multidisciplinary plan of care for patients with complex medical and socio-economic problems; provides real time interventions to ensure compliance with health care regulations; meets with new admission patients to identify continuum and discharge needs; ensures documentation of initial discharge planning assessment within the first 72 hours.
Identifies and documents proper level of care; discusses cases with attending and physician advisor; identifies anticipated length of stay; works with attending on clinical pathway or MCG guideline; proactively assists in resolving barriers; develops and implements case management plans and interventions; performs discharge planning; completes responsibilities by following established guidelines and protocols within the appropriate timeframe.
Initiates the discharge plan and documents interventions; updates care plan weekly; confirms Face Sheet information; assures proper hand off for transfers; communicates discharge plan to new case manager; assesses need for referrals to outside resources; obtains authorizations for Home Care, Home IV infusion and DMEs; coordinates forms or electronic referrals; arranges transportation; meets departmental performance expectations for home care/hospice and equipment; confirms services and contact information.
Identifies readmissions within 30 days; performs walking rounds and identifies high‑risk patients; works with Social Work and utilization management to reduce LOS and prevent denials; coordinates and manages distribution of IMM and assists with MOON; conducts or co‑leads care coordination rounds; promotes working relationship with patient/family; acts as advocate; works closely with Social Work and utilization management; serves as a resource regarding patient classification and reimbursement.
Demonstrates competency with computer programs; achieves Department Team Dashboard Score Card goals; escalates avoidable days; completes mandatory trainings and in‑services; demonstrates knowledge of safety, security and infection control risks; participates in quality improvement by collecting and analyzing data, identifying trends and suggesting improvements; participates on clinical process improvement teams.
Demonstrates commitment to excellent customer service; will rotate on weekends to provide coverage; understands and adheres to University Hospital compliance standards; keeps abreast of pertinent federal, state and hospital regulations, laws, and policies.
Performs other related duties as assigned.