Case Manager

United Regional•Wichita Falls, TX

About The Position

Encompasses the process of case management practice in partnership with the medical staff and members of the clinical team accountable for outcomes of selected patient populations. Accountable to the patient and the community and is responsible for facilitating the patient’s safe, cost efficient, progression-of-care throughout the entire episode of acute care and assuring the patient’s timely and seamless transition back to the community.

Requirements

High School diploma or equivalent
Associate degree or Bachelor’s Degree in Nursing
Must be able to communicate effectively in English, both verbally and in writing.
Registered Nurse with current Texas license and in good standing with governing board in Texas
At least 5 years recent hospital experience and knowledge of CMSA’s case management standards of practice.
High degree of interpersonal and communication skills
Vocal, visual, auditory, physical, and manual ability to adequately perform clinical psychosocial interventions.
Must have basic computer knowledge including word processing and navigational skills
Must be able to demonstrate the ability to work effectively as a healthcare team member and prioritize work.
Ability to demonstrate proficiency in use and application of all electronic tools
Must have effective written and verbal communication skills, be a positive relationship builder, ability to effect change, perform critical analysis, plan and organize effectively.

Nice To Haves

Nationally recognized certification in Case Management preferred.
Current certification in Basic Life Support (BLS) preferred.
Current CPI training preferred.

Responsibilities

Advocate for patient by assessing that patient healthcare needs are being addressed at the most appropriate level of care. Assesses patient situation by collecting information from patient and family, professional and non-professional caregivers, employers (as appropriate), and health records to identify individual needs to develop a comprehensive progression-of-care management plan that will address those needs.
Communicates, consults and coordinates with medical advisor as necessary to resolve progression-of-care barriers through appropriate administrative and medical channels. Serve as primary liaison between clinical team. Maintain appropriate documentation on each patient to include specific information of all planning, liaison, and coordination activities. Educates members of the patient’s healthcare team on the appropriate access to, and use of various levels of care. Recognizes and responds appropriately to risk factors. Assess the effectiveness of services and their outcomes in concert with the interdisciplinary team, recommending appropriate plan modifications to assure treatment objectives are met.
Pro-actively participate as a member of the interdisciplinary clinical team to confirm appropriateness of the treatment plan relative to the patient’s preference, reason for admission, and availability of resources. Actively participate in daily rounding meetings, patient care conferences, and hospitalist/nurses hand-off reports to gather sufficient information to determine the effectiveness of the treatment plan and patient care goals. Identify and record episodes of preventable delays or avoidable days due to failure of progression-of-care processes. Understand and apply federal law regarding the use of HINNs, ABNs, and medical necessity criteria. Assertively collaborate and manage resource utilization while appropriately navigating the patient's movement along the continuum of care.
Collaborate with nursing and members of the clinical team to provide patient/family education regarding discharge goals that require the team’s expertise (medication administration, transferring to/from a car, oxygen use, etc). Research discharge placement options, when home discharge is not possible, while continuing to focus on patient/family goals, interdisciplinary team recommendations, available payer benefits and private financial considerations which may impact placement.
Communicates and coordinates with Utilization Review Nurses (URN) for correct bed status confirmation and medical necessity for continued stay. Work closely with URN to identify and assist with trend determination of outlier cases. Facilitate and ensure appropriate clinical documentation for level of services and acuity of care accurately reflected in the medical record.
Assure discharge plan is addressed during daily rounds, keeping patient/family objectives in mind while modifying the plan as appropriate. Update all involved parties regarding progress, revisions and other information related to the discharge plan. Demonstrates mature negotiation and conflict management strategies and skills. Coordinate post -acute needs and assure seamless hand-offs to the most appropriate community provider
Uses interpersonal skills which convey a positive and supportive attitude and is straightforward and tactful in language (e.g.: active listening, good communication, telephone etiquette). Demonstrate knowledge of current regulatory and accrediting agency requirements as it pertains to obtaining services for patients. Demonstrates flexibility in response to unexpected changes in work volume, emergency staffing, and scheduling. Participate in follow-up processes to discharged patients to query about quality and timeliness of post-acute arrangements.
Searches for and takes advantage of leadership opportunities to enhance own professional growth. Maintains self-direction and demonstrates ability to resolve issues pro-actively. Maintains current working knowledge through review of national organizations via list serves, meetings, newsletters and journals. Consistently attends meetings.
Preserve the basic human rights of expression, decision, action and personal dignity for all patients and families. Respect the cultural diversity of all patients, families and employees of United Regional Health Care System.
Performs all other tasks/responsibilities as necessary.