RN Case Manager

Cary Medical Center•Caribou, ME

12d

About The Position

The Case Manager is accountable for organizing the resources necessary to achieve patient outcomes within effective time frames and coordinating the plan of care among members of the health care team. The role requires the ability to practice under minimal supervision and perform the four essential activities of case management: assessment, planning, implementation, and coordination. The Case Manager helps reduce practice variations and enhance patient outcomes. The position includes assessing patient needs, developing and evaluating case management plans, coordinating resources and care across the interdisciplinary team, and managing service approvals, authorizations, appeals, and denials. The Case Manager also monitors resource management protocols and avoidable days, supports infection reporting, participates in quality improvement, and acts as a supervisor on weekends and holidays while coordinating bed management with charge nurses.

Requirements

Active, valid Maine RN license.
Recognize quality-of-care and risk issues and report them to the appropriate individual.
Assess age-specific data in relation to patient needs.
Obtain working knowledge of criteria used to assess levels of care within one month of hire.
Maintain annual nursing competencies.
Acquire ACLS certification within the first year of hire.
Availability to work nights, weekends, and holidays depending on department staffing needs.

Responsibilities

Assess individual patient needs and develop a comprehensive case management plan using information from patients, families, caregivers, employers, and health records.
Monitor information relevant to the case management plan and conduct concurrent reviews every 1–3 days for service intensity, setting appropriateness, and discharge planning.
Evaluate the effectiveness of case management plans, reassess significant changes in patient status, and revise plans as needed before discharge.
Determine objectives, goals, and actions to meet patient needs, and implement plans in a timely manner, involving the Physician Advisor as necessary.
Coordinate and integrate resources with patients and facilitate Interdisciplinary Team Meetings.
Maintain current knowledge of insurance reimbursement structures, network provider lists, approval criteria, and appeals processes.
Negotiate approval and authorization of services and facilitate appeals or responses to denials with physicians and/or the Physician Advisor.
Maintain productive working relationships with payer-source case managers and complete work accurately and within acceptable time frames.
Use sound judgment in situations not covered by written or verbal instructions and demonstrate knowledge of work practices, emergency procedures, and personal protective equipment.
Complete CDI on inpatient charts.
Coordinate care across the health care team and serve as a liaison among patients, families, and health care staff throughout the continuum of care.
Monitor resource management protocols and avoidable days.
Ensure identification and reporting of nosocomial infections to the Infection Control Coordinator.
Coordinate department work, set priorities, reduce non-essential interruptions, and respond to department and Medical Center needs.
Analyze situations and make timely decisions using planning, research, foresight, and facility goals while involving appropriate parties.
Promote and educate employees about excellent customer service.
Consult the manager for additional assignments or assume responsibility for unassigned tasks.
Participate in Quality Improvement activities and offer suggestions for process improvements.
Accept constructive criticism, adjust schedules when workload or departmental needs fluctuate, channel concerns appropriately, and foster teamwork and collaboration.
Participate in department meetings and contribute suggestions and input.
Assume responsibility for ongoing professional development.
Act as supervisor on weekends and holidays and coordinate bed management with charge nurses.
Comply with local, state, and federal laws and regulations.