The Case Manager coordinates the care and service of selected patient populations across the continuum. He/she works collaboratively with patient, family, physician and other members of the health care team to achieve the highest quality clinical outcomes with the most cost effective use of available resources. The Case Manager assumes responsibility for an interdisciplinary process which assesses, plans, implements, monitors and measures the effectiveness of interventions to meet patients' treatment and transitional needs. The Case Manager is knowledgeable about various age-related care protocols and functions within their scope of practice. This position is established to actively participate on the patient care team by providing basic bedside care and assisting patients with activities of daily living, under the direction of the RN. Teamwork is a vital component to same, through effective collaboration efforts.
Collaborates with the patient, family, physician and other health care professionals to perform initial and concurrent patient assessment and referrals / recommendations
Uses severity of illness/intensity of services indexes to determine appropriateness of admissions, transfers and continued stays;
Advocates for adherence to best practice standards through use of approved guidelines, protocols and order sheets;
Provides physicians and ancillary departments with data on treatment outcomes and avoidable delays in order to promote highest quality care;
Works in conjunction with Payer Specialists in communicating and negotiating with commercial payers or other outside agencies in order to obtain needed services for patients and accurate reimbursement for the hospital
Takes a leadership role in identifying opportunities to reduce risks, both financial and clinical, through analysis of resource consumption outcomes
II. Transitional Planning
Works with interdisciplinary team to coordinate needed services to ensure efficient continuity of care.
Assesses need for services through collaboration via Bedside Rounding on patients as well as with physicians and other interdisciplinary team members
Plans for care needs with active involvement of patient, significant others, hospital staff involved in treatment process;
Oversees implementation of transition plans with support from internal and external agents;
Monitors patients' progress and adequacy of planning process through regular communication with patients and service providers;
Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/agencies adhering to legal mandates about confidentiality;
Measures effectiveness of interventions through direct communication with patients and caregivers and data collection of defined indicators (e.g., overall length of stay, readmission rates, feedback from referral sources, etc.).
Identifies problems or gaps in community resources that impact outcomes and takes leadership role in efforts to effect changes.
III. Advocacy for Quality Outcomes
Acts as a patient advocate for optimum care and a business partner to the physician.
Participates as a team member to facilitate communication among all disciplines, identify barriers to meeting treatment goals, and determine ways to achieve best outcomes; as evidenced by facilitating and actively participating in Bedside Rounding
Provides information and support to patients and families, helping them access needed resources within the medical center and community;
Assists physicians in obtaining needed services for their patients and having access to all available data on best practice and financial outcomes;
Cultivates collegial partnerships with physicians and other health care professionals and maintains high customer satisfaction ratings in dealing with patients and their significant others;
Demonstrates innovative problem-solving skills and ability to analyze and organize data to provide evidence for necessary process changes.
IV. Professional Development
Takes responsibility for adhering to case management standards of practice, hospital and departmental policies and procedures, and for professional development.
Performs all assigned tasks according to standards defined by the Case Management Society of America and other relevant professional groups;
Promotes a safe and effective work environment by following institutional guidelines for work activities, reporting any variances to department director immediately.
Participates actively in relevant educational programs and shares information with other members of department and health care team;
Maintains knowledge base about relevant clinical and fiscal issues and about community resources.
Participates actively in staff meetings, designated hospital committees and community groups/task forces.
Takes an active role in appraisal process, documenting achievements and defining goals for self and department annually.
Collaborates with other case managers to ensure effective and efficient operations, using effective communication skills to share information and constructive feedback.
ASPN, ADN or BSN in nursing. Or AS or BS in Social Work. Must have current Licensure in either Nursing or Social Work.
Licensure: Current, state licensure or approved Compact state licensure (valid for initial 30 days)
Minimum - three years in acute care hospital
Preferred - experience in case management, discharge planning or utilization management role
Familiarity with case management role in health care setting
Knowledge of medical terminology, utilization management criteria, community resources, and health care reimbursement systems
Ability to analyze data, apply critical thinking process to problem-solving
Demonstrated capacity to work with inter- disciplinary team (especially physicians) and communicate effectively
Knowledge of InterQual and/or Milliman criteria is preferred
Moderate computer skills required
Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
Adheres to and exhibits our core values:
Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.
Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.
Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.
Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality.
Maintains confidentiality and protects sensitive data at all times.
Adheres to organizational and department specific safety standards and guidelines.
Works collaboratively and supports efforts of team members.
Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.
Catholic Health Initiatives and its organizations are Equal Opportunity Employers
Nursing - RN
ND-Dickinson-St Joseph's Hospital And Hlth
Scheduled Hours per 2-week Pay Period
For Catholic Health Initiatives (CHI), returning sick people to good health is more than a business -- it's a mission. Formed in 1996...