Nurse Case Manager RN - Rehab Unit

Confluence Health•Wenatchee, WA

5d•Onsite

About The Position

The Case Manager position is responsible for communicating and facilitating care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self-determination through a collaborative practice model including patients, nurses, social workers, physicians, other practitioners, caregivers, and the community.

Requirements

One to three years clinical experience.
Current licensure in the state of Washington (RCW 18.88) (AD or BSN) or licensure through Multistate Nurse Licensure Compact (SSB 5499).
Basic Life Support certification (within 90 days of hire).
Excellent interpersonal communication and negotiation skills.
Strong analytical, data management and PC skills.
Understanding of venues of care and community resources.
Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families.
Performs duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety, cost efficiency, and a commitment to the CQI process.

Nice To Haves

Professional certification as a Case Manager encouraged within two years of employment.

Responsibilities

Facilitate the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.
Apply process improvement methodologies in evaluating outcomes of care.
Coordinate communication with physicians.
Ensure the development of a safe and effective plan of care through early identification and thorough assessment of the patient’s needs and the resources available.
Work collaboratively and maintain active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.
Provide patient/family/caregivers available tools/resources to make informed choices.
Educate patient/families/caregivers and health care team on the economic impact of their care options.
Arrange services among community agencies, physicians, patient/family/caregivers, and others involved in the plan of care.
Monitor progress toward the goals of the plan and ensure revisions in response to changes in patient needs and condition, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
Address/resolve system problems impeding diagnostic or treatment progress.
Proactively identify and resolve delays and obstacles.
Utilize an organizationally defined escalation process to refer facets of the care plan beyond the control or influence of the team.
Utilize advanced conflict resolution skills as necessary to ensure timely resolution of issues.
Facilitate the progression of care by advancing the care plan to achieve desired outcomes and integrate the work of the health care team by coordinating resources and services necessary to accomplish agreed-upon goals.
Collaborate with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
Complete Quality Screening for assigned patients.
Identify at-risk populations using approved screening tool and follow established reporting procedures.
Refer case and issues to Care Management Medical Director in compliance with Department procedures and follow up as indicated.
Discuss payor criteria and issues on a case-by-case basis with clinical staff and follow up to resolve problems with payors as needed.
Use quality screens to identify potential issues and forward information to Clinical Quality Review Department.
Ensure that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
Collaborate/communicate with internal & external case managers.
Initiate and facilitate referrals for home health care, hospice, medical equipment and supplies.
Facilitate transfer to other facilities as appropriate.
Actively participate in clinical performance improvement activities.
Assist in the collection and reporting of resource and financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
Use data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data.
Collect, analyze and address variances from the plan of care/care path with physician and/or other members of the healthcare team.
Use concurrent variance data to drive practice changes and positively impact outcomes.
Collect delay and other data for specific performance and/or outcome indicators as determined by Director or Manager of Case Management.
Document key clinical path variances and outcomes which relate to areas of direct responsibility.
Use pathway data in collaboration with other disciplines to ensure effective patient management concurrently.
Ensure safe care to patients adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
Promote individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, support department-based goals which contribute to the success of the organization; serve as a preceptor, mentor, and resource to less experienced staff.
Maintain active Basic Life Support (CPR) certification.
Perform other duties as assigned.
Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.