The Case Manager utilizes the nursing process for age and diagnosis of specific populations to assess, plan and evaluate the care of a designated case load of patients so that clinical and financial outcomes are achieved. Holds primary responsibility for oversight of Care Coordination, Utilization Review and Discharge Planning for all patients, providing direction and delegation as appropriate to accomplish. Responsible for appropriate utilization of medical necessity criteria and provides guidance to medical and other clinical staff in their use.
- Directs, coordinates and supervises the care delivered to his/her caseload.
- Communicates with patients, families, physicians, staff and other customers.
- Contributes to modifications in nurse and physician practice patterns to continuously improve quality of care, patient satisfaction and appropriate use of resources.
- Maximizes positive financial outcomes for his/her designated case types.
- Utilizes consistent processes to assure that all patients are evaluated and monitored for appropriate resource consumption.
- Participates in the Case Management/Utilization Review Committee formal processes.
- Provides focused discharged planning, initiated as early as possible after admission, to facilitate timely and appropriate discharges.
- Education: Graduation from accredited program of nursing; BSN preferred.
- Licensure/Certification: Current state Registered Nurse license or license from a state within the Nursing Compact.
- Experience: Minimum of 3 years clinical experience in cardiovascular nursing preferred. Two years of case management experience preferred.
Arkansas Heart Hospital - 13 months ago