Lead Case Manager RN

Jefferson Health Plans • Philadelphia, PA

31d • Onsite

About The Position

The Lead 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. Coordinate all aspects of discharge planning and establishes a safe discharge plan for assigned patients. In the Lead role, assists Leadership by providing clinical expertise and knowledge. Assists Department leaders in day to day departmental operations.

Requirements

• Bachelor’s Degree of Nursing
• 2 years case management or discharge planning experience
• Healthcare Regulatory Environment Knowledge and understanding of legislation and regulatory bodies affecting healthcare practices.
• Medical Ethics Knowledge of practices, behaviors, applicable laws, rules and regulations governing proper medical conduct.
• Patient Rights Knowledge of principles and practices associated with the rights and responsibilities of patients and caregivers.
• Discharge Planner Knowledge of the patient’s post-discharge needs and the ability to consider these needs in planning for discharge and arranging for follow-up care.
• Case Management Knowledge of procedures and resources for assisting patients and monitoring case plans for patients.
• Clinical Policies and Standards Knowledge of and ability to use industry standards, policies and procedures relevant to function and organization.
• Demonstrate effective use of conflict resolution skills as necessary to ensure timely resolution of issues.
• Demonstrate efficient prioritization and time management skills.
• Refers appropriate cases for Social Work intervention and involvement.
• Documents all relevant information in the Medical Record according to Department policies and procedures.
• RN - Licensed Registered Nurse_PA - State of Pennsylvania or RN - Licensed Registered Nurse_NJ - State of New Jersey

Responsibilities

• Meets with patient/family to assess needs to complete an initial Case Management Assessment per Department policy and procedure, then develops an initial discharge plan.
• Facilitates patient progression throughout the patient’s hospital stay.
• Functions as a resource for the staff in addressing discharge planning issues.
• Assists in removing patient progression barriers to discharge.
• Advocates for the patient and family throughout the entire episode of care.
• Functions as a resource to facilitate communication among the healthcare team and the patient/family.
• Reviews patient’s status daily to identify issues requiring priority interventions or attention which may impact the established discharge plan.
• Reviews patient LOS/barriers data to facilitate patient’s progression during Multidisciplinary Rounds and Escalation/Outlier meetings.
• Delivers the MOON to observation status patients within the required timeframe (Center City).
• Ensures appropriate patients receive the second copy of the CMS IM within 2 days of discharge (Center City).
• Facilitates patient transfers to other acute care hospitals.
• Communicates with identified Department staff to initiate and facilitate referrals and authorizations for post-acute care services and any medical necessity issues.
• Refers cases and identified issues to the Physician Advisor in compliance with departmental procedures and follows up as indicated.
• Keeps supervisor informed of any issues.
• Facilitates daily patient Plan of Care Huddle Rounds functioning as the Patient Progression Leader.
• Monitors patient’s progress intervening as necessary to ensure patient progresses efficiently to discharge.
• Proactively identifies and resolves barriers to patient care and/or progression to discharge.
• Escalates unresolved barriers to Department Leadership.
• Participates in the completion of daily staffing, ensuring coverage for weekends and holidays.
• Makes daily assignments for specific areas.
• Attends daily hospital bed/patient safety huddles and provides follow-up on identified concerns.
• Communicates information to Manager/Director.
• Coordinates and supervises department specific orientation of newly hired staff with support from the Manager.
• Facilitates identified meetings in the absence of the Manager or Director.
• Provides feedback to the Manager/Director related to staff performance.
• Promotes teamwork through organizing team recognition, employee engagement activities in partnership with the Manager and Director.
• May attend campus specific meetings representing the Department in the absence of the Manager/Director.
• Coordinates Medicare discharge appeal process including providing the Detailed Notice of Discharge and follow-up with the outcome.
• Takes weekend/holiday “on call” for clinical or administrative responsibilities to address and resolve departmental issues.
• Escalate unresolved issues to supervisor.
• Covers for the Manager in their absence.

Benefits

• medical (including prescription)
• supplemental insurance
• dental
• vision
• life and AD&D insurance
• short- and long-term disability
• flexible spending accounts
• retirement plans
• tuition assistance
• voluntary benefits
• tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level