Case Manager, RN- Case Management

166750\n\nJob Description\n\nServes as liaison between the patient and facility / physician. Ensures a continuum of quality patient care throughout hospitalization and oversees provisions for patient's discharge. Assesses, plans, oversees and evaluates the appropriateness of care throughout admission and hospitalization of the patient.\n\nJob Responsibility\n

• Facilitates patient management throughout hospitalization.\n
• Participates in patient management rounds and patient centered meetings.\n
• Identifies potential delays and resolves issues with appropriate departments.\n
• Identifies appropriate utilization of Social Work Services and makes referrals when appropriate.\n
• Confers with physician regarding referrals for Physical Therapy, nutrition, speech and swallow.\n
• Serves as an in-patient liaison - planning, assessing, implementing and evaluating patient in collaboration with the health care team.\n
• Serves as a resource to the health care team regarding quality, utilization of clinical resources, payer, and reimbursement issues.\n
• Works with on-site screeners in transitioning patients to appropriate post discharge settings.\n
• Collaborates with payers, providing all necessary clinical documentation for the maximization of benefits.\n
• Serves as a liaison to patient, family, admitting, primary care physician, health care team, and hospital departments.\n
• Collaborates with and provides feedback to the primary care physician and multidisciplinary team regarding patient's status with regard to length of stay, utilization of resources and discharge status.\n
• Provides support to the in-patient health care team as well as to patient and family regarding all aspects of admission, hospitalization and discharge plan.\n
• Involves patient and / or family in discussion and planning for anticipated need for care following discharge.\n
• Ensures patient and / or family are given information regarding their choices regarding transferring the patient to another level of care according to regulatory standards.\n
• Performs concurrent utilization management using Interqual criteria.\n
• Conducts chart review for appropriateness of admission and continued length of stay.\n
• Contacts and interacts with third party payers to obtain approval of hospital days, pre-certification and post-discharge eligibility in relation to clinical course.\n
• Ensures compliance with current state, federal, and third party payer regulations.\n
• Identifies patients for Alternate Level Care (ALC) care list and notifies appropriate health team members.\n
• Communicates with insurance companies and physicians regarding utilization issues.\n
• Utilizes important message from Medicare (IMM) when appropriate.\n
• Ensures managed care reviews are up to date and accurately reflect patient's clinical progress and acute needs.\n
• Participates in the quality management of patient care outcomes.\n
• Submits data to management regarding case management and / or quality initiatives.\n
• Participates in data collection regarding patient's length of stay, utilization of clinical resources, IPRO citations including appropriate recommendations and re-admission within 30 days.\n
• Initiates appropriate discharge planning as supported by initial assessment at time of admission\n
• Reviews patient's chart.\n
• Assesses each patient physically, psychosocially and financially.\n
• Assesses patient's support system to facilitate appropriate discharge to community.\n
• Substantiates, with the physician, the need for home care services.\n
• Coordinates procurement of any supplies, equipment or home lab work needed by patient to evaluate discharge.\n
• Arranges for post-hospital transportation, when indicated.\n
• Interacts and coordinates with community agencies, families, vendors facilities and institutions to facilitate patient discharge.\n
• Documents the case management process in the medical record.\n
• Completes and documents a psychosocial assessment on the patient.\n
• Documents on-going processes of patients' hospitalization.\n
• Documents finalized discharge plan and disposition.\n
• Completes applicable areas of the Patients Discharge Instruction Sheet and the Patient Transfer Sheet.\n
• Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile of the patient.\n
• Ensures case management sheet is current and accurate.\n
• Performs related duties, as required.\n
• ADA Essential Functions\n\nJob Qualification\n
• Bachelor's Degree in Nursing, required.\n
• Current license to practice as a Registered Professional Nurse in New York State.\n
• Case Management Certification, preferred.\n
• Minimum of one (1) year related experience, required. Experience in case management and clinical pathways, variance analysis and trending, quality management / utilization review and home care / discharge planning, preferred.\n
• Keeps abreast of developments in the field and serves as a resource to other staff.\n
• Patient Review Instrument certification required.\n\nAdditional Site-specific Qualifications May Apply\n
• Additional Salary Detail The salary range and / or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and / or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).