Complex Inpatient Case Manager

American Addiction Centers•Winston-Salem, NC

3d•$41 - $62•Onsite

About The Position

The Complex Inpatient Case Manager performs thorough patient assessments to identify critical health issues and implements targeted interventions and patient-family centered care plans to achieve optimal health outcomes. This role involves collaborating and negotiating effectively with clinically complex patients, families, and the clinical team to achieve patient and organizational goals regarding care needs, choices, and satisfaction during discharge planning and care transitions. The position also involves aggregating, analyzing, interpreting, and reporting data on patient outcomes and resource utilization, and facilitating reporting of utilization monitoring and review activities. The Case Manager provides continuity of care and discharge planning services for clinically complex patients in compliance with regulatory standards, offering coordinated, relevant options and services based on assessed needs. They also provide advanced clinical guidance and mentorship to frontline care management team members, lead initiatives to enhance care quality, patient safety, and healthcare delivery efficiency, and advocate for patients and their families within the healthcare system while optimizing hospital resource utilization for cost-effective care delivery and regulatory adherence. Additionally, they initiate internal and external referrals, document interventions and utilization review activity, and perform concurrent and retrospective reviews. The role requires effective communication with the healthcare team, partnership with Social Work and unlicensed support personnel, and leadership in multidisciplinary rounds to resolve barriers to discharge and expedite care delivery. As an expert, they collaborate with managers, physicians, and treatment teams on best practices for patient care plans, refer cases to physician advisors as needed, and maintain knowledge of healthcare regulations, reimbursement issues, and community resources. They also develop and maintain relationships with community-based agencies and collaborate with Advocate Health Ambulatory Care Management and Continuing Health. The position requires knowledge and skills appropriate for the age of patients served, understanding principles of growth and development over the lifespan.

Requirements

Registered Nurse License issued by the State in which the team member practices.
2 years of clinical nursing experience
3 years of care management experience
Ability to prioritize and organize work.
Effective communication skills.
Utilization of critical thinking and timely decision making.
Ability to navigate the electronic health record.
Basic utilization of MS Office products.
Knowledge of Medicare A and B guidelines.
Knowledge of managed care program requirements/implications.
Ability to apply elements of utilization management programs.

Nice To Haves

Accredited Care Manager (ACM) certification issued by the American Case Management Association (ACMA) needs to be obtained within 2 years
Care Manager Certified (CMC) certification issued by the National Academy of Certified Care Managers (NACCM) needs to be obtained within 2 years
Nurse Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within two (2) years.

Responsibilities

Perform thorough patient assessments, identifying critical health issues and implement targeted interventions and patient-family centered care plans to achieve optimal health outcomes.
Collaborate and negotiate effectively with clinically complex patients, family and the clinical team while striving to achieve patient and organizational goals regarding care needs, choices, and satisfaction during discharge planning and care transitions.
Aggregate, analyze, interpret and report data on patient outcomes and resource utilization.
Facilitate reporting of utilization monitoring and review activities to relevant committees and stakeholders.
Provide continuity of care and discharge planning services for clinically complex patients compliant with regulatory standards.
Offers coordinated, relevant options and services based on assessed needs to ensure patient, families, and the healthcare team are informed and prepared to proceed with accountabilities in a timely manner.
Participate in the communication processes to facilitate smooth transitions for patients, families, and staff during patient transfers.
Provide advanced clinical guidance and mentorship to frontline care management team members fostering a culture of excellence and continuous improvement.
Lead initiatives aimed at enhancing care quality, patient safety, and overall healthcare delivery efficiency.
Advocate for patients and their families to ensure their voices are heard and their needs are met within the healthcare system while optimizing the utilization of hospital resources ensuring cost-effective care delivery and adherence to regulatory guidelines.
Initiate internal and external referrals to assure timely progression of care and transitions for clinically complex patients.
Document discharge planning interventions and utilization review activity according to department and organization standards in a timely manner.
Perform and document accurate and timely concurrent and retrospective reviews for clinically complex patients based on approved criteria by department standards.
Communicate effectively with the healthcare team regarding clinically complex patients.
Partner with Social Work and unlicensed support personnel to effectively establish and implement a safe plan of care.
Serves as a leader of the multidisciplinary rounds and work closely with clinical team members, hospital departments and ancillary services to identify and resolve barriers to discharge, expedite care delivery to avoid delays in timely service provision, and implement and report on care coordination and discharge planning.
As an expert in care management of clinically complex patients, collaborate and lead discussions with managers, physicians, medical directors, advisory groups, and treatment teams for issues related to physician practices and best practices for the patient care plans.
Refer cases to physician advisors as needed to ensure efficient progression of care, accurate status, and compliance with regulatory guidelines.
Maintain knowledge of healthcare regulations, reimbursement issues, impact on length of stay and community-based resources.
Deliver CMS regulatory notices within CMS established timeframes, as appropriate based on-site guidelines.
Develop and maintain productive relationships with community-based agencies, particularly those serving clinically complex patients.
Represent Advocate Health in a positive manner, working collaboratively, internally and externally to meet patient and family needs.
Collaborate with Advocate Health Ambulatory Care Management and Continuing Health to achieve mutual goals and outcomes.
Demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served.
Understand principles of growth and development over the lifespan and possess the ability to assess data reflective of the patient status and interpret the appropriate information needed to identify each patient’s age-specific needs, and provide the care needed as described in departmental policies and procedures.

Benefits

Comprehensive suite of Total Rewards: benefits and well-being programs
Competitive compensation
Generous retirement offerings
Programs that invest in your career development
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program