JOB SUMMARY

This position is responsible for providing comprehensive assessments on patients (pediatric and adult patients) and being the primary liaison between the patient / family and the treatment team. The Case Manager ensures that the patient’s individualized treatment plan is carried out in a focused, cost effective, goal directed manner. As a member of the interdisciplinary team the case manager will also facilitate the development, coordination, and implementation of the discharge plan as well as any other outside arrangements to ensure continuity of care.
Responsibilities:
The Case Manager conducts initial admission assessments and identifies patients who do not meet criteria and ensures patients receive the most appropriate level of care. The Case Manager actively participates in daily rounds to coordinate care in conjunction with other members of the healthcare team and provides and facilitates optimal health care/discharge planning.

Under the direction of the Manager or Director of Care Coordination or CNO, the Case Manager performs activities which support the Care Coordination Department including:

• Promotes optimal management of clinical resources by conducting timely initial admission assessments based on clinical indicators and anticipated service needs for appropriate level of hospital care; Validates patient demographics and payor source
• Utilizes and contributes to the development of the multidisciplinary clinical assessment of patients on an on-going basis during the patient’s admission to ensure the quality and appropriateness of patient care
• Implements, reassesses, and evaluates patient condition and coordinates plan of care daily; Develops patient specific plan of care based on the individual needs of the patients, conversations with providers and other staff, and documentation in electronic medical record (EMR.) Ensures updated plan of care is documented in the EMR
• Coordinates the discharge needs of patients with necessary internal and external providers while protecting patient information
• Performs timely, professional, and appropriate documentation as reflected in the Quality Review Audit process
• Advocates for patient/family needs in a respectful, non-judgmental, and confidential manner
• Serves as a liaison or facilitator for the patient and interdisciplinary healthcare team in the management of unusual or questions cases. Educates the healthcare team about the role of the RN: Case Manager. Is accessible to the healthcare team as a resource.
• Appropriately refers cases to manager/director of care coordination, CAO, or medical director when intensity of service or severity of illness is not present and is unable to be resolved
• Ensure delivery of Discharge Medicare Important Message (IM) and Medicare Outpatient Observation Notice (MOON), where applicable
• Acknowledges, addresses, and completes are Consults to Case Management on respective units in EMR

REQUIRED QUALIFICATIONS

• Licensed or eligible for license in Kentucky
• Basic Life Support (BLS) accredited by the American Heart Association (AHA)
• Bachelor’s degree from accredited college or University or RN with a Bachelors Degree in Business or Health Care Administration preferred. Will consider RN with A.D.N. if actively pursuing BSN, with BSN completion required within 2 years of hire.
• Must have 2-3 years experience as an RN plus utilization management or discharge planning/case management experience. Minimum two years experience performing utilization review and/or quality assurance activities in an acute care facility or HMO/PPO/PRO preferred. Must be able to adjust priorities quickly, organize multiple tasks simultaneously, and work interdependently with many levels of staff. Attention to detail; strong organizational, interpersonal and communication skills; and innovative problem solving skills required. Must be able to adjust work hours depending on depending upon departmental needs as determined by the director or manager.

PREFERRED QUALIFICATIONS

• Certification in a nursing specialty area or CCM

Please refer the Job description for details