Case Manager

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.