Case Manager RN

University of Maryland Medical System•Woodlawn, MD

45d•Onsite

About The Position

Under general supervision of the Manager, Case Management, this role coordinates the clinical and financial plan for patient assignments. Responsibilities include overall utilization management, resource management, discharge planning, care facilitation, and referral to other levels of care. The Case Manager RN works with the physician and interdisciplinary team to achieve desired quality and financial outcomes.

Requirements

Current licensure as a Registered Nurse in the State of Maryland is required.
Bachelor's degree in Nursing, or related field required for new hires effective 9/2019.
A minimum of three years’ experience in clinical nursing in a hospital setting is required.
Experience in utilization management, case management, and/or discharge planning is strongly preferred.
Excellent problem-solving, team-building, analytical and communication skills are required.
Knowledge and application of current computer technologies are required.
Ability to work independently; display flexibility and adaptability is required.
Highly effective verbal communication skills including courtesy, resourcefulness and efficiency in answering questions, giving directions, locating staff and explaining hospital/departmental policies and procedures are necessary.
Verbal communication skills may include communicating with an interdisciplinary team, patients, and families.
Effective writing skills are also required in order to take messages and maintain miscellaneous records, receipts, reports and logs.

Nice To Haves

Additional experience in home care, transitional care, or insurance arena, preferred.
Certification in Case Management is preferred.

Responsibilities

Coordinates the clinical and financial plan for patient assignments.
Performs overall utilization management, resource management, discharge planning, care facilitation, and referral to other levels of care.
Works with the physician and interdisciplinary team to achieve desired quality and financial outcomes.
Accurately and concisely records interactions along the continuum from admission to discharge, meeting case management documentation standards.
Submits complete and accurate reports of tracking activities within established time-frame and format.
Demonstrates creative and resourceful critical thinking and problem-solving abilities in discharge planning.
Assesses appropriateness of admission, continued stay, and discharge of patients.
Represents the organization in a professional manner.
Demonstrates age-appropriate interactions with all patients, providing care appropriate to age, culture, ethnicity, and specific individual diagnostic needs.
Consistently expresses and demonstrates compassion and courtesy for patients, extending courtesy and support to patient's families/visitors.
Coordinates and provides leadership and direction to team conferences.
Promotes and participates in team building activities.
Establishes and maintains an effective means of communicating pertinent information to interdisciplinary team members, manager, patients and families.
Maintains confidentiality in accordance with hospital policy and professional standards.
Refers identified clinical issues and lapses in standards of care to appropriate areas.
Identifies the need for guardianship appointment and makes appropriate referrals.
Maintains hospital and department policies, procedures, and objectives, as well as safety, environmental, and infection control standards.
Ensures patient safety in the performance of job functions and through participation in hospital, and unit/program patient safety initiatives.
Takes action to correct observed risks to patient safety.
Reports adverse events and near misses to appropriate management authority.
Implements policies, procedure, and standards consistently in the performance of assigned duties.
Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.
Remains vigilant to potential problems and takes action accordingly.
Coordinates and leads Family Conferences and participates in Rounds, Plan of Care Meetings/Team Conferences.
Collaborates with the interdisciplinary team to facilitate a continuum of care to meet internal and external customer needs.
Acts as the liaison with the interdisciplinary team, the patient/family/support network and the managed care organization.
Fosters a well-coordinated care experience for the patient, family, and care providers.
Models excellence in customer service behaviors in daily practice.
Identifies and acts on opportunities to respond to customer requirements.
Takes action to prevent potential customer complaints.
Incorporates good customer service skills into daily practice.
Collaborates in the assessment of the patient including appropriate social, emotional and financial resources, discharge needs, and problems identified as barriers to discharge.
Collaborates with the unit program manager and the interdisciplinary team to develop, implement and evaluate an interdisciplinary plan of care and prioritized goals.
Involves the patient, family and support network in the process of developing, implementing, and monitoring the plan of care and goals.
Facilitates the discharge planning process by coordinating a viable discharge plan for the removal of barriers to discharge which meets the patient's individual needs; links the patient with the most appropriate institutional and community resources; advocates on behalf of the patient to ensure a smooth continuum of care.
Explores strategies to reduce length of stay and resources consumption by sharing observations with the interdisciplinary team, promotes the implementation of recommendations to the team, and documents all results.
Provides appropriate interventions and assistance with problem solving each individual case as needed.
Completes and submits all required written documents accurately and timely (e.g. Denial and Appeal report).
Provides information to and confers with the managed care representatives to promote attainment of goals, continuity of care, and positive patient outcomes.
Contributes to the departmental budget process.
Maintains current knowledge/expertise in the area of specialty.
Attends and participates in department meetings, in-service training and educational programs for continued professional growth and development.
Other duties as assigned.