RN-Case Manager

Job Summary

Case Managers will apply systems, science, incentives, and information to
improve healthcare practice and assist patients and their support systems to
become engaged in a collaborative process designed to manage
medical/social/mental health conditions more effectively. The case manager's
objective is to achieve an optimal level of wellness for patients and improve
coordination of care while providing cost effective, non-duplicative services.
Performs all other duties as assigned.

Responsibilities

* Assess and document the clinical, psychosocial and financial needs of
patients including availability of care support, risk for readmission and
safe environment upon discharge/transition and payor benefits. Findings are
collected by interviewing patients, caregivers and members of the
interdisciplinary team. Aspects of this assessment obtained from the patient
record or previous case manager assessment are validated, updated and
influence the plan of care. Assess and document the patient's care management
and potential discharge needs. 20 %
* Apply InterQual to determine/validate Level of Service and Intensity of Care.
Utilize InterQual criteria within the first 24 hours of arrival to complete
an initial review. Collaborate with physicians, Manager of Case Management
and physician advisors to resolve conflicts. Coordinate with bed control to
attain proper placement. Perform concurrent reviews of medical records to
ensure continued appropriateness and make recommendations based on the needs
of the patient. Escalate and facilitate resolution of unjustifiable aspects
of care that vary from InterQual guidelines. 20 %
* With the physician, identify the plan of care, estimated length of stay and
transition/discharge plan. Meet with patients and families to engage them in
the plan and obtain agreement. Incorporate all processes and procedures into
the plan to ensure safe discharge/transition. Coordinate with physician and
nurse to make plan adjustments as patient condition indicates. Use best
practices and available pathways to anticipate the course of care through
discharge/transition. Incorporate ancillary services as needed. Work in
collaboration with social work for complex postacute placement and community
service resources. 20 %
* In coordination with nursing, ancillary departments, social work, and the
physician, monitor and ensure the treatment plan and steps to prepare for
transition or discharge are completed as planned, gaps in care are avoided as
well as duplicative or unnecessary services. 10 %
* Ensure that patients are discharged/transitioned timely and appropriately and
that variances from the plan or target discharge/transition date are
documented. 10 %
* Escalate concerns and barriers to appropriate treatment or transition as
outlined by the department. 10 %
* Maintain a working knowledge of facilities and resources available to
patients and caregivers. 10 %

Specifications

Experience

Minimum Required

* 3 years Healthcare/Medical-Acute Care Required.

Preferred/Desired

* Healthcare/Medical-Case Manager Preferred, or Healthcare/Medical -
Utilization Review Preferred.

Education

Minimum Required

* Graduate of School of Nursing-Accredited Required.

Preferred/Desired

* Bachelor's Degree Nursing Preferred, or Bachelor's Degree Allied Health
Preferred.

Training

Minimum Required

Preferred/Desired

Special Skills

Minimum Required

* Must be able to work with acutely & chronically ill patients of all ages and
their caregivers. Must have excellent interpersonal communication,
multi-tasking, prioritizing & organizational skills. Demonstrated ability to
work effectively with teams in a collaborative manner and escalate issues
appropriately. Ability to work weekends and flexible hours per the department
staffing plan.

Preferred/Desired

Licensure

Minimum Required

* License/Certification/Registries (valid for the State of MS): Registered
Nurse (RN) by the State Board of Nursing Required.

Preferred/Desired

* Certification by the Case Management Society of America Preferred, or
Equivalent Certification Preferred.