To provide clinically based case management to support the delivery of effective and efficient care in the inpatient and Emergency Department settings. Accountable for the utilization management, care coordination, and discharge planning for patients within the assigned case load. Collaborates with Social Services and other members of the health care team to identify appropriate utilization of resources to ensure reimbursement and quality outcomes. |
Case Management Manager
Education, Experience and Skills Requirements
Must have a Bachelor's degree in Nursing. An Associate's degree in nursing plus Case Management Certification would be acceptable qualifications if hired prior to 2013. Must have a minimum of three years of clinical practice. Knowledge and experience in case management highly preferred.
Must hold current licensure as a Registered Nurse in North Dakota. Case Management certification preferred for BSN RNs. If previous to 2013 Associate's Degree Registered Nurse hire does not have case management certification, must obtain within three years.
Job Specific Competencies
- Reviews all assigned admissions utilizing InterQual system to validate medical necessity for appropriate patient status (inpatient, observation, or outpatient), collaborates with physicians as appropriate.
- Initiates discharge planning for scheduled admissions through collaboration with the clinic, assesses all other admissions within 24 hours to initiate discharge planning. Refers complex discharge planning needs to Social Services.
- Collaborates with physicians, nursing, and other members of the multidisciplinary team to operationalize a single plan of care to improve efficiency and effectiveness of patient throughput.
- Collects data to identify potential avoidable days and other indicators to provide feedback and identify the need for system improvements.
- Oversees the denial of coverage process, prepares and administers the appropriate denial of coverage notice(s), and interacts with payers regarding continuation of stay and denial prevention or reversal.
- Educates members of the healthcare team on assigned unit regarding documentation, status, expected length of stay, and anticipating discharge.
- Interacts with customers in a warm and friendly way.
- Takes immediate action to meet customer requests or needs.
- Listens to understand what customers have to say.
- Recognizes safety hazards and takes corrective action; seeking assistance when needed.
- Demonstrates knowledge of operational policies and procedures.
- Performs work safely, without causing harm or risk to self, others or property.
- Makes a decision considering the impact of the decision on other areas.
- Initiates collaboration with others outside of service area.
- Demonstrates personal commitment to the principles, values, and ethics of the organization.
- Models accountability for learning by sharing knowledge and learning from others.
- Builds effective working relationships.
- Expresses appreciation to others for their work.
- Treats others with respect.
- Demonstrates both knowledge and application of Sanford policies, procedures, and guidelines.
- Demonstrates the ability to take charge, take unpopular stands if necessary, face difficult situations, and is looked to for direction from others.
- Facilitates and supports change within the Sanford Health.
- Demonstrates commitment to continuous learning for themselves and staff.
- Demonstrates and applies continuous quality improvement knowledge and skills.
Information Management Competencies
- Demonstrates skill in accessing, preparing and using information as relevant to position.
- Verbalizes and demonstrates knowledge of procedures for maintaining security, confidentiality and integrity of employee, patient, family and other medical information.
- Demonstrates ability to collect, analyze and present data as appropriate to position.
- Demonstrates skill in use of equipment relevant to position; verbalizes knowledge of appropriate safety procedures.
Professional/Clinical Practice Competencies
- Assessment: Collects health data from patient/family.
- Planning: Develops a plan of care in collaboration with patient, family, and other health care providers.
- Implementation: Implements the services/needs as identified in the plan of care.
- Evaluation: Evaluates the patient's progress toward the attainment of outcomes.
- Documentation: Gathers, documents, and transmits important patient information throughout the system.
- This position is classified as a Category III position under OSHA guidelines with no risk of exposure to bloodborne pathogens and other potentially infectious materials.
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