Overview
The Case Manager is accountable for coordinating the care and service of selected patient population across a continuum of care; ensuring and facilitating the achievement of optimal quality, clinical and cost outcomes; coordinating services and resources needed by the patient and family; and assuming a leadership role with the multidisciplinary team.
Responsibilities
- Coordinates and collaborate with physicians, provider, multidisciplinary team and other health care professionals concerning patient’s goals, plan of care and progress.
- Develop, implement, interpret and maintain work standards and procedures that are in compliance with ARH’s policies and governmental regulations and various regulatory agency requirements.
- Maintain up-to-date knowledge in the field to allow recommendation of new services, products and equipment.
- Assesses, develop, implementation, and monitors comprehensive plan of care through an interagency multi-disciplinary team process in conjunction with the patient and family internal and external settings.
- Revise and adjust on a daily basis the plan of care to accommodate the needs of the individual patient based on continuing assessment of patient condition.
- Assumes responsibility and accountability for the care plan and effectiveness and patient outcomes.
- Assesses the appropriateness of the level of care; diagnostic testing and clinical procedures; quality and clinical risk issues; and documentation of medical record completeness.
- In accordance with hospital sanctioned ISDA criteria and/or other established criteria, reviews all patient admission data to determine the suitability of the level of care.
- Develop, implement, monitor and evaluate clinical pathways and clinical pathway variances.
- Monitor patients progression through clinical pathways.
- Communicates continually with patients, families, medical staff, caregiver and third-payors as necessary.
- Assist the patients and families with the educational process prior to admission, during hospital stay and after discharge, as indicated.
- Assures patients understand the third-party payer guidelines and to arrange discharge planning referrals as ordered by patients’ physicians.
- Develops and maintains a positive work climate and supports the overall team effort of the hospital.
- Assists in collecting and analyzing outcome data.
- Performs other duties as assigned or directed.
Qualifications
Education
• BSN preferred with 5 years experience in a hospital/community setting; OR
• Must complete BSN or degree in other related field within 5 years; OR
• RN with MSN or degree in other related field with 3 years experience;
Licenses & Certifications
• Must meet all Licensure and Certification requirements in state working; OR
• Must obtain Certification of Case Management Society of America.
• Must have a valid driver's license in state working.
Required Skills, Knowledge & Abilities
• Excellent oral and written communication skills.
• Must possess skill and proficiency in applying highly technical principles, concepts and techniques that are central to the nursing profession.
• Excellent organizational skills.
• Must travel to patients' residences, agencies, and network providers as necessary.
• Required to be cross-trained in UR, QA, discharge planning, and infection control.
