Job Description
Schedule: Monday through Friday 8am-4:30pm with rotating weekends with team members and 1-2 holidays a year.
The Case Manager reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
Under the general supervision of the Director of Case Management, the Nurse Case Manager will assess all patients within their defined geographical scope of service. The Nurse Case Manager will, based on expert assessment, determine case management needs and intervene as appropriately. The Nurse Case Manager will participate as part of the multi-disciplinary team on all cases with identified needs for care coordination. The Nurse Case Manager will work closely with the multi-disciplinary team to determine appropriateness of care and work to maximize care and services and the efficiency and quality of movement of patients through the care continuum. The Nurse Case Manager participates as a participant or primary care coordinator depending on the complexity of the case and the needs of the patient. In collaboration with the RN staff and charge nurse; the Nurse Case Manager collaborates and coordinates the care needs to facilitate the patient through the care continuum. The RN is viewed as the primary patient care "provider" during the patient's hospital stay. The Nurse Case Manager is the primary care "coordinator" to move the patient through the care continuum. Works to ensure optimal quality and efficiency of patient care and services.
- Through active involvement in the patient's care, the Nurse Case Manager expedites the patient’s progression along the continuum of care to effect timely and appropriate care coordination.
- Assists hospital in meeting budgeted LOS by managing ADOD for assigned patients.
- Participates in LOS rounds by providing knowledgeable clinical specifics for patient information including discharge plan and barriers.
- Works closely with the multidisciplinary team to ensure patient flow through capacity management techniques.
- Trends care delivery related issues and provides information to the Health Team.
- Communicates all regulatory concerns lo the Healthcare Team.
- Collaborates with the patient, family, designated caregivers and multidisciplinary team to facilitate prioritization of care along the continuum.
- Collaborates with staff, physicians, and other clinical providers to manage and direct care to reduce variances from expected outcomes.
- Intervenes to correct variances to include avoidable days.
- Meets directly with the patient/family and develops as individualized plan of care in collaboration with the multidisciplinary team. Re-evaluates and revises the plan of care as necessary.
- Communicates and at times rounds with the physician to establish and support the plan of care, address issues regarding acute care stay and manage resource utilization.
- Assists physicians, care providers, patient and family in understanding payer plans and benefits as required.
- Proactively initiates and facilitates consultations from appropriate disciplines/departments as required to expedite care, monitor length of stay and facilitate a timely safe discharge.
- Collaborates with Utilization Review regarding insurance concerns and verification of acute and post-acute benefits, manage concurrent denials, and manage patient status changes including observation and code 44.
- Monitors readmission issues and escalates to the Healthcare Team.
- Assures compliance with governmental regulations including Medicare three day inpatient stay for skilled nursing facility, Important Message from Medicare, observation status and code 44.
- Participate in the assurance of core measure compliance and best practice principles in the care management of patients.
- Assesses and monitors customer satisfaction and responds promptly to voided and identified concerns regarding care coordination. Escalates issues to other departments as appropriate.
- Assures compliance with the Department of Public Health, The Joint Commission, CMS and other regulatory agencies.
- Collaborates with the team in development of the patient's plan of care and educational needs.
- Guides the multidisciplinary team members in the patient's progression through the care continuum
- Participates in data collection and data analysis regarding patient through put.
- Assists with implementation of protocols, clinical guidelines and patient's plan of care.
- Assists patients and families in understanding medical recommendations and the discharge plan.
- Collaborates with social service and nursing staff in discussing the availability of community resources.
- Partners with physicians to develop and implement the post-acute plan of care.
- In collaboration with the multi-disciplinary team and, if applicable, post discharge services; coordinates or serves as a resource in the discharge process and ensures that the patient and family understand the discharge plan.
- Documents assessments, actions and patient outcomes as indicated by department work processes.
- Participates in patient education and documentation of that education specifically related to governmental regulations.
- In the event of a Medicare Appeal by a patient, Case Management would reassess the patient, determine any opportunities for care or education, and work with the Multidisciplinary Team to reevaluate the plan of care.
- Performs patient assessments through the systematic collection and review of patient- specific data and communicates assessments appropriately.
- Assesses patient/family learning needs, plans and provides education and evaluates the effectiveness of teaching in achieving desired outcomes.
- Identifies and responds appropriately to ethical issues in patient care; provides nursing care and intervention in a non-judgmental manner that respects patient diversity and acknowledges patient rights.