Case Manager (Inpatient Units)

Ellis Medicine•Schenectady, NY

16d•$34 - $51

About The Position

The RN Case Manager has responsibility for case management of assigned patients on a designated unit(s). This position works with the physicians and interdisciplinary team to facilitate and maintain compassionate, efficient quality care and achievement of desired treatment outcomes. The Case Manager confirms admission and continued stay are medically necessary and ensures the interdisciplinary care plan and the discharge plan are consistent with the patient’s required needs and covered services. Support services provided by the Case Manager include, but are not limited to, utilization review, case management, care transition, collaboration with physicians and social workers for care coordination and discharge planning.

Requirements

Current license or valid permit to practice professional nursing in the state of New York
Associate’s degree in nursing required, Bachelor's degree in nursing strongly preferred
Two years of inpatient experience in a hospital environment preferred.

Nice To Haves

Previous case management, utilization review, and discharge planning experience highly preferred.
Home care, payer, or other experience will be considered.

Responsibilities

Meets with patient and/or family/personal representative as soon as possible, to assess, evaluate, and identify discharge needs
Screens patient for post-hospital needs throughout the continuum and makes appropriate referral for those identified; as well as, the high risk population, chronic medical problems, non-compliance issues, interdisciplinary and/or patient, family, requests
Participates in interdisciplinary rounds, identifies anticipated discharge date and discharge plan and promptly escalates barriers to leadership
Acts as a role model, maintains professional standards and collaborates with patients, families, caregivers, interdisciplinary team members, external agencies, insurance companies as needed to effectively execute discharge planning services, such as but not limited to: coordinating/leading team/family meetings, timely completion of NYS Peer Review Instrument and Screen, skilled nursing facility referrals and meetings, durable medical equipment referrals, ensuring completion of ambulance forms, discharge checklist and/or med-eval, etc…
Develops a comprehensive discharge plan and oversight of the assigned unit
Ensures that discharge planning plays a key role in the internal efficiency of the hospital by timely intervention for a low Length of Stay via identification of patient status – inpatient vs. outpatient/observation, resolving barriers to discharge, identifies and verifies payment source for services and equipment prior to implementation of discharge plan
Collaborates and makes referrals to physician advisor when unable to resolve issues with attending physician
Documents thoroughly and accurately in medical record
Collaborates with physician and other members of the interdisciplinary team to develop, plan, and facilitate a safe and realistic discharge plan, re-evaluating every 3 days or adjusting as patient’s condition changes throughout patient’s hospitalization
Documents thoroughly and accurately in medical record
Identifies patients with complex discharge planning needs and complex psychosocial needs and coordinate transition of care with Social Worker
Serves as nurse consultant for Social Worker cases with Clinical or discharge planning needs
Coordinates acute hospital to hospital transfers to ensure compliance with all the discharge planning regulations and transfer policy
Provides guidance, support, and back-up to social workers on patients in need of transfer, medical review and care planning
Coordinates, plans, and participates in interdisciplinary discharge planning meetings, identifying barriers to discharge with participation of all disciplines
Assures completion of discharge forms, i.e. Important Message from Medicare, PRI, and transportation within established timeframes and according to state/federal regulations
Adheres to the New York State Department of Health and Centers for Medicare and Medicaid Services discharge planning guidelines and departmental/organizational policies and processes
Ensures order in chart/EMR coincides with the InterQual review or CMS rules and regulations for appropriate Level of Care and status on all patients through collaboration with Utilization Review RN
Contacts the attending physician for additional information if the patient does not meet the appropriate InterQual guidelines or in accordance with CMS rules and regulations for continued stay
Assesses and evaluates the medical necessity and appropriateness of ancillary testing, medications, treatment, and plan of care, discussing concerns with the involved physician, nurse or ancillary staff member. Make appropriate referral to physician advisor regarding trends/areas of concern
Proactively monitors patient activity, identifying and resolving delay and barriers to discharge.
Monitors length of stay, readmissions, and documents avoidable days for trending and performance improvement purpose
Attends necessary in-services; seeks learning experiences and gathers medical/community knowledge as needed.
Perform other duties as assigned and as listed in department Roles and Responsibility Grids