RN Case Manager - FT Day

Jefferson Health Plans•Philadelphia, PA

3d•Onsite

About The Position

The 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. Coordinates all aspects of discharge planning and establishes a safe discharge plan for assigned patients.

Requirements

of Nursing
case management or discharge planning experience
Demonstrates effective use of conflict resolution skills as necessary to ensure timely resolution of issues.
Demonstrates efficient prioritization and time management skills.

Nice To Haves

Precept and mentor new staff members to their role and department.

Responsibilities

Advocates for the patient and family throughout the entire episode of care.
Functions as a resource to facilitate communication among the healthcare team and patient/family.
Facilitates patient progression throughout the patient’s hospital stay.
Reviews patient length of stay/barriers data to facilitate patients’ progression during Multidisciplinary Rounds and Escalation/Outlier meetings.
Reviews patients’ status daily to identify issues requiring priority interventions or attention which may impact the established discharge plan.
May facilitate daily patient Plan of Care Huddle Rounds functioning as the Patient Progression Leader or supports the identified Patient Progression Leader.
Monitors patient’s progress intervening as necessary to ensure patient progresses efficiently.
Proactively identifies and resolves barriers to patient care and/or progression to discharge.
Escalates unresolved barriers to Department Leadership.
Applies specific relevant medical necessity criteria for all patients to determine the appropriate patient status or continued need for hospital level of care (Center City).
Documents appropriate medical necessity criteria level of care guidelines subset (InterQual)(Center City).
Follows departmental procedures for Condition 44 downgrades, including medical record documentation, and informing patient and relevant department staff.
Adheres to organizational policies and procedures, identified third party payer contract utilization management workflows and governmental payer processes.
Applies initial DRG for all inpatients and document in the Care Advance (applicable hospitals).
Completes an initial assessment to assess patient’s needs and resources for discharge planning.
Establishes discharge plan including homecare services, transportation, post-acute facility placements.
Ensures all Post-Acute authorizations are secured for patients discharge.
Precept and mentor new staff members to their role and department.
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.
Refers appropriate cases for Social Work intervention and involvement.
Documents all relevant information in the Medical Record according to Department policies and procedures.
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.

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.