Overview
The Case Manger will coordinate care using a collaborative approach with the multidisciplinary team in identifying the required services needed to meet an individual’s health needs while hospitalized. The UCMRN will be expected to identify, intervene and expedite issues which may adversely affect the length of stay and quality of care by communicating and using all available resources.
Internal posting from Sept 14-Sept 27
Responsibilities
- Establish and maintain positive relationships with patients, visitors, and other employees. Interacts professionally, courteously, and appropriately with patients, visitors and other employees.
- Contributes to and participates in the Performance/Quality Improvement activities of the assigned department including data collection, analysis, implementation of and compliance with risk management and claims activities.
- Develop an individualized case management plan to assure appropriate and timely utilization of hospital, community based and other resources for optimal, cost effective discharge planning.
- Conduct patient and family assessment for all admissions to assigned unit utilizing approved criteria, critical pathways and established algorithms within 24 hours of admission.
- Identify risk factors and intervene with appropriate parties to resolve and/or prevent delays and optimize a smooth transition through all levels of care.
- Maintain knowledge of Managed Care requirements, DRG, insurance benefits, IPRO regulations and nationally recognized medical necessity criteria.
- Coordinate interdisciplinary discharge planning team conferences to monitor appropriateness of the discharge plan.
- Frequent interaction with attending physician(s) to facilitate the timeliness in rendering quality patient care.
- Participate in interdisciplinary unit rounds and serve as a resource person for Nursing, Ancillary and Medical staff.
- Conduct screening and case findings in cooperation with other health care professionals.
- Coordinate and facilitate services rendered and resource utilization for cases managed.
- Identify and report problematic cases with extended LOS providing updated information to Utilization Case Manager and/or Director.
- Enter data related to admission, continued stay and discharge planning into the 3M HDM system.
- Conduct focus studies for the purpose of trending, benchmarking and improving care rendered.
- Acts as patient advocate.
- Dialogues with home care liaison practitioner or managed care organization to ensure compliance with continued outpatient treatment.
Qualifications
BSN, Current NYS license to practice as a Registered Professional Nurse. Successful completion of Commission for Case Management Certification (CCMC) within three (3) years of hire, if not currently certified. Minimum three (3) years of clinical experience in Nursing; preferably in Case Management. Experience with InterQual and Milliman Care Guidelines preferred.
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