RN-Case Manager- Medical Alt - Memphis

Baptist•Memphis, TN

About The Position

Case Managers apply systems, science, incentives, and information to improve healthcare practice and help patients and their support systems engage in a collaborative process to manage medical, social, and mental health conditions more effectively. The objective is to achieve an optimal level of wellness for patients and improve coordination of care while providing cost-effective, non-duplicative services. Performs all other duties as assigned. The case manager assesses and documents patients’ clinical, psychosocial, financial, care-management, and potential discharge needs. Assessments include care support availability, readmission risk, a safe discharge or transition environment, and payer benefits. Information is gathered through interviews with patients, caregivers, and the interdisciplinary team; information from patient records and previous assessments is validated and updated to inform the care plan. The role uses InterQual criteria to determine or validate level of service and intensity of care, conducts an initial review within the first 24 hours of arrival, performs concurrent medical-record reviews, and collaborates with physicians, case-management leadership, physician advisors, and bed control to address conflicts and ensure appropriate placement and care. Working with physicians, patients, families, nursing, ancillary departments, and social work, the case manager develops and monitors the plan of care, estimated length of stay, and transition or discharge plan. The role coordinates services, addresses barriers and gaps in care, supports safe and timely transitions, documents variances, and maintains knowledge of facilities and resources available to patients and caregivers.

Requirements

At least 3 years of healthcare/medical acute-care experience.
Graduate of an accredited school of nursing.
Must be able to work with acutely and chronically ill patients of all ages and their caregivers.
Excellent interpersonal communication, multitasking, prioritizing, and organizational skills.
Demonstrated ability to work effectively and collaboratively with teams and escalate issues appropriately.
Ability to work weekends and flexible hours according to the department staffing plan.
Valid Registered Nurse (RN) license from the State Board of Nursing for the State of Mississippi.

Nice To Haves

Healthcare/medical case-management experience.
Healthcare/medical utilization-review experience.
Bachelor’s degree in Nursing or Allied Health.
Certification by the Case Management Society of America or equivalent certification.

Responsibilities

Assess and document patients’ clinical, psychosocial, financial, care-management, and potential discharge needs, including care support availability, readmission risk, discharge environment, and payer benefits.
Gather and validate assessment information through interviews with patients, caregivers, interdisciplinary team members, patient records, and prior case-manager assessments.
Apply InterQual criteria within the first 24 hours of arrival to determine or validate level of service and intensity of care.
Collaborate with physicians, the Manager of Case Management, and physician advisors to resolve conflicts; coordinate with bed control to attain proper placement.
Perform concurrent medical-record reviews to ensure continued appropriateness of care and make recommendations based on patient needs.
Escalate and facilitate resolution of unjustifiable aspects of care that vary from InterQual guidelines.
Work with physicians to identify the plan of care, estimated length of stay, and transition or discharge plan; engage patients and families and obtain their agreement.
Incorporate processes and procedures into the plan to ensure safe discharge or transition, and coordinate adjustments with physicians and nurses as patient conditions change.
Use best practices and available pathways to anticipate care through discharge or transition, incorporate ancillary services as needed, and collaborate with social work on complex postacute placement and community resources.
Coordinate with nursing, ancillary departments, social work, and physicians to monitor the treatment plan and transition or discharge preparations, avoiding care gaps and duplicative or unnecessary services.
Ensure timely and appropriate discharge or transition and document variances from the plan or target date.
Escalate concerns and barriers to appropriate treatment or transition according to department procedures.
Maintain working knowledge of facilities and resources available to patients and caregivers.
Perform other duties as assigned.