Case Manager RN

Thomas Jefferson University • Philadelphia, PA

14d • Onsite

About The Position

With a commitment to patient and family-centered care, the Case Manager RN uses the nursing process in ways that values the uniqueness of each individual and addresses the physical, psychological, emotional, and social needs of the diversity of patients served by Jefferson Health. The Case Manager RN utilizes advanced nursing skills and knowledge to comprehensively coordinate care for a defined patient population to facilitate patients through the continuum of care. Coordinates all aspects of discharge planning and establishes a safe discharge plan for assigned patients. The Case Manager RN collaborates with physicians, nurses, social workers and other health team members to expedite medically appropriate, cost-effective care. Responsibilities include risk assessment and management of clinical populations and discharge planning. The Case Manager RN act as a patient advocate and helps patients and their families understand their health status and treatment options while ensuring that the patient receives the assistance necessary to follow through with their personal treatment plan. Job Description Interacts with co-workers, patients, their families/designated care partner(s), and other staff consistent with the values of Jefferson. Integrates evidence based practice, clinical expertise, patients, their family/designated care partner(s) preferences and cultural beliefs and values for delivery of optimal health care. Partners with patients, their family/designated care partner(s) in identifying learning needs and priorities and provides education in ways that is useful, understandable and affirming. Advocates for the patient and family throughout the entire episode of care. Functions as a resource to facilitate communication among the healthcare team and patient/family. Facilitates patient progression throughout the patient’s hospital stay. Reviews patient length of stay/barriers data to facilitate patients’ progression during Multidisciplinary Rounds and Escalation/Outlier meetings. Reviews patients’ status daily to identify issues requiring priority interventions or attention which may impact the established discharge plan. May facilitate daily patient Plan of Care Huddle Rounds functioning as the Patient Progression Leader or supports the identified Patient Progression Leader. Monitors patient’s progress intervening as necessary to ensure patient progresses efficiently. Proactively identifies and resolves barriers to patient care and/or progression to discharge. Escalates unresolved barriers to Department Leadership. May facilitate Condition 44 downgrades, including medical record documentation, and informing patient and relevant department staff. (in conjunction with UR nurse) Ensures all Post-Acute authorizations are secured for patients discharge. Precept and mentor new staff members to their role and department. May provide the MOON notice to observation status patients within the required timeframe. (In conjunction with UR nurse) May provide the patients with the second copy of the CMS IM within 2 days of discharge. Facilitates patient transfers to other acute care hospitals.

Requirements

• Bachelors of Nursing required
• Minimum of 1-2 years of acute care clinical experience

Nice To Haves

• Minimum of 1-2 years case management or discharge planning experience preferred.

Responsibilities

• Interacts with co-workers, patients, their families/designated care partner(s), and other staff consistent with the values of Jefferson.
• Integrates evidence based practice, clinical expertise, patients, their family/designated care partner(s) preferences and cultural beliefs and values for delivery of optimal health care.
• Partners with patients, their family/designated care partner(s) in identifying learning needs and priorities and provides education in ways that is useful, understandable and affirming.
• Advocates for the patient and family throughout the entire episode of care.
• Functions as a resource to facilitate communication among the healthcare team and patient/family.
• Facilitates patient progression throughout the patient’s hospital stay.
• Reviews patient length of stay/barriers data to facilitate patients’ progression during Multidisciplinary Rounds and Escalation/Outlier meetings.
• Reviews patients’ status daily to identify issues requiring priority interventions or attention which may impact the established discharge plan.
• May facilitate daily patient Plan of Care Huddle Rounds functioning as the Patient Progression Leader or supports the identified Patient Progression Leader.
• Monitors patient’s progress intervening as necessary to ensure patient progresses efficiently.
• Proactively identifies and resolves barriers to patient care and/or progression to discharge.
• Escalates unresolved barriers to Department Leadership.
• May facilitate Condition 44 downgrades, including medical record documentation, and informing patient and relevant department staff. (in conjunction with UR nurse)
• Ensures all Post-Acute authorizations are secured for patients discharge.
• Precept and mentor new staff members to their role and department.
• May provide the MOON notice to observation status patients within the required timeframe. (In conjunction with UR nurse)
• May provide the patients with the second copy of the CMS IM within 2 days of discharge.
• Facilitates patient transfers to other acute care hospitals.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps ), have access to medical (including prescription) insurance.
• For more benefits information, please click here

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees