Case Manager RN
About The Position
The Case Manager is responsible for evaluating, coordinating, and implementing the functions of Utilization Review and Discharge Planning in order to coordinate: (1) quality of patients care, (2) cost effective outcome management, (3) communication between patients, families, and members of the healthcare team, (4) facilitation of movement of patients through appropriate levels of care, (5) activities and equipment necessary to transition to home. Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.
Requirements
- Bachelor's degree (B. A.) from four-year College or university; or one to two years related experience and/or training; or equivalent combination of education and experience.
- Associate’s degree (A.D.N.) with five years’ related experience required.
- Registered and currently licensed by the Board of Nurse Examiners for the State of Texas.
- Current CPR certification (American Heart Association BLS)
Nice To Haves
- Bilingual skills in Spanish preferred.
- National certification in applicable are to be obtained with 2 years of eligibility.
Responsibilities
- Maintains utmost level of confidentiality at all times.
- Adheres to hospital policies and procedures.
- Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
- Identifies patients who need discharge planning services.
- Identify high risk or potential problematic cases based on predetermined internal trigger mechanisms.
- Develops and reviews each stage of care, analyzes patterns of variance and implements strategies to resolve them.
- Documents resource management activities separately from the medical record.
- Involves patient caregiver in plan of care, allowing family to be as independent as possible with plan of care; therefore, ensure cost effective care.
- Assess patient/family needs thoroughly.
- Reassesses patient/family needs as needed.
- Cross –training and ability to perform the essentials duties of UR/CM as needed.
- Participates in regular peer discussions and collaboration regarding the management of the caseload and seeks peer consultation about cases that are presenting problems and/or significant variances.
- Collaborates closely with Social Workers to ensure effective communication and planning for patients’ needs.
- Participates in quality improvement activities to improve the delivery of high-quality, cost-effective patients care as evidenced by documentation, observed behavior. And verbal written feedback.
- Maintains professional standards through licensure, certification, education, and development.
- Consults with hospital staff and physicians regarding patients’ continuity of care needs.
- Identifies best practice patterns based on comparative data.
- Documents discharge planning activities in the medical record.
- Collaborates and communicates with providers, members of healthcare team, payers, patients and family members for purposes of coordinating care, understanding needs of families and payers and for identification of healthcare needs that extend beyond the hospital stay.
- Demonstrates working knowledge of payer and accrediting agencies.
- Participates in family conferences when indicated, and acts as a liaison between hospital and community agencies when making referrals for DME, nursing care, supplies or therapy.
- May be involved in nursing or hospital-wide committee for program development and information sharing.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
