Case Manager, RN

Overview

Under the general supervision of the case management Director acts as a patient advocate / case manager to hospital clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. Looks for opportunities to reduce cost while ensuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care. Works collaboratively with interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care.

Responsibilities

Assessment

• Does the initial screening of all elective in patient admissions related to : Level of careAppropriateness of admission (IS-SI)Discharge needsThird party contractual arrangementsAppropriate resource utilizationCoordinates the pre-admission screening and education of the identified patient populationsCoordinates out-of-area transfersDocuments patients admitted directly through Pre-Admissions in the laptop system and forwards the information on to the Case Managers as appropriate with discharge planning concerns and the initial discharge-planning screen

Technical and Job Specific Skills

Performance / Process Improvement

Guest / Interdepartmental Relations

Productivity

Key Success Factors

Communicates with nursing and other hospital personnel, regarding laboratory procedures, results, etc.

Professional Conduct

Professional Growth and Development

Performance Improvement

Additional Responsibilities

Department-Specific Competencies

Qualifications