RN-Case Manager

Reid Health

1d•Onsite

About The Position

The Case Manager coordinates with the interdisciplinary team to expedite medically appropriate, cost-effective patient care. The Case Manager applies clinical expertise and medical appropriateness criteria to resource utilization, care coordination, and transition/discharge planning; advises the healthcare team, and provides intervention as needed to achieve optimal outcomes. The Case Manager applies the use of data in his/her practice; identifying where to focus efforts, the measurement of progress towards identified outcomes, and as an educational tool. This individual possesses excellent interpersonal, negotiation, influence, and organizational skills and works to effect positive practice changes that lead to improved value in patient care delivery.

Requirements

Minimum education required: Associates, Bachelor's, or Masters Degree in Nursing
Minimum experience required: 5 years of experience in healthcare setting
Minimum licensure required: Licensure in State of Indiana as a Registered Nurse, BLS

Responsibilities

Conducts utilization review/management as outlined in the UR Plan and assigned duties.
Performs concurrent reviews to evaluate the patient’s condition and treatment plan for medical necessity, clinical appropriateness, completeness, and progression.
Initiates transition/discharge planning.
Anticipates an appropriate length of stay based on the initial review and plans concurrent reviews accordingly.
Complies with all utilization review regulations and payer agreements (e.g., Medicare Hospital Issued Notices of Non-Coverage, Detailed Notice of Discharge).
Proactively facilitates the patient’s plan of care, providing necessary anticipatory guidance to healthcare team members, patients, and families.
Reviews the patient’s plan of care with the patient’s physicians, discharge planners, nurses, healthcare team, and payers (as applicable).
Offers suggestions, coordinates care, determines the transition plan with the interdisciplinary team, and resolves variances.
Works collaboratively with discharge planners and refers complex home discharges and placements.
Utilizes designated physician advisors to address challenges, provide education, and resolve internal barriers.
Coordinates patient care conferences as necessary.
Serves as a consultant to staff, physicians, management, and other healthcare professionals, sharing knowledge regarding standards of care and best practices to ensure the successful implementation of the patient’s plan of care.
Collaborates with all disciplines to identify and address cost reduction opportunities related to the use of resources.
Ensures timely execution of the patient’s discharge/transfer plan.
Documents appropriate interventions in the patient’s medical record.
Collects, utilizes, and trends process and outcomes data to identify problems related to efficiency and quality of care issues as directed.
Trends, analyzes, and reports outcomes, clinical processes, and variance data to appropriate audiences.
Participates in process and outcome improvement activities, such as protocol development, and facilitates approved practice changes.
Attends appropriate physician and Nurse Leader meetings to report on trends, outcomes, and statistics for the assigned population.
Receives and acts on feedback from physicians and nursing management related to Case Management.
Achieves length of stay and resource consumption targets for the assigned patient population.
Performs other duties as assigned to accomplish the goals of the organization.