RN - Case Manager (Acute Care) - Care Management

Glens Falls Hospital•City of Glens Falls, NY

4d•$39 - $60

About The Position

The Case Manager (Acute Care) role must optimize and integrate the interface between clinical and financial systems supporting positive health outcomes. Under the general supervision of the Director and/or Supervisor of Care Continuum, the Case Manager uses nursing and case management knowledge to promote appropriate allocation of hospital and other resources, while striving to provide high quality care to each patient in a cost-effective and timely manner. Support services provided by the Case Manager include, but are not limited to, utilization review, case management, weekend and holiday case management, care transition, collaboration with physicians and social workers for care coordination and discharge planning. Our Mission is to improve the health of people in our region by providing access to exceptional, affordable, and patient-centered care every day and in every setting.

Requirements

Bachelors of Nursing (BSN) is preferred at hire, and is required within 5 years of hire. Exceptions may be made for Associate’s degree RN with relevant experience and obtains certification in case management (CCM or ACM) within 1 year.
Minimum of two years of experience in a hospital environment strongly preferred
Home care, payer, or other experience will be considered
Registered Nurse (RN) in New York State
Ability to function autonomously maintaining a high level of clinical and professional accountability
Demonstrates skill in creative problem solving, facilitation, collaboration, coordination and critical thinking
Embraces change and continuously identifies opportunities for improvement by demonstrating a commitment to creativity and innovation
Committed to promoting excellence in Customer Service; functions as a team player
Computer literacy and data analysis skills are required
Maintains professional image by demonstrating strong verbal and written communication skills
Demonstrates ability in self-starting, self-directing and clear decision-making behaviors

Responsibilities

Ensures order in chart/EMR coincides with the InterQual review or CMS rules and regulations for appropriate Level of Care and status on all patients through collaboration with Utilization Review RN.
Assesses the patient’s plan of care as soon as possible on admission and re-evaluates the plan of care at least every 3 days utilizing InterQual criteria to determine appropriate Level of Care and patient status.
Contacts the attending physician for additional information if the patient does not meet the appropriate InterQual guidelines or in accordance with CMS rules and regulations for continued stay.
Collaborates and makes referrals to physician advisor when unable to resolve issues with attending physician.
Meets with patient and/or family/personal representative as soon as possible, but not greater than 48 hours of admission, to assess, evaluate, and identify discharge needs. Provides support and information, as needed.
Collaborates with physician and other members of the health care team to develop, plan, and facilitate a safe and realistic discharge plan, re-evaluating every 3 days or adjusting as patient’s condition changes throughout patient’s hospitalization.
Assesses and evaluates the medical necessity and appropriateness of ancillary testing, medications, treatment, and plan of care, discussing concerns with the involved physician, nurse or ancillary staff member. Make appropriate referral to physician advisor regarding trends/areas of concern.
Identifies patients with complex discharge planning needs and complex psychosocial needs and coordinate transition of care with Social Worker.
Coordinates post-discharge plans with appropriate referral sources in a timely fashion. Coordination of aftercare services and task should include verbal hand-offs and written referrals, if indicated. Patients and their caregiver (support system) are to be educated on the services that will support them after discharge. Early and often communication with patient and family support positive outcomes and contribute to avoiding delays in discharge and potentially avoidable readmissions.
Coordinates, plans, and participates in interdisciplinary discharge planning meetings, identifying barriers to discharge with participation of all disciplines.
Assures completion of discharge forms, i.e. Important Message from Medicare, PRI, and transportation within established timeframes and according to state/federal regulations.
Proactively monitors patient activity, identifying and resolving delay and barriers to discharge. Monitors length of stay, readmissions, and documents avoidable days for trending and performance improvement purposes.
Identifies patients with complex discharge planning needs and complex psychosocial needs and coordinate transition of care with Social Worker.
Follows the expectations of the department’s care manager role and responsibility grids
Demonstrates the knowledge and skills necessary to provide appropriate care in consideration of the growth development, and social needs of pediatric, adolescent, adult, and geriatric patients.
Relays any barriers or concerns regarding any aspect of their role to the Director or Supervisor of Care Continuum.
Continuously pursue excellence in meeting the needs and expectation of all customers (patients, families, inter-disciplinary team members, payors, screener, liaisons and outside services and agencies.