RN Care Manager, 7E 40 Hours (Days / 4 10hr shifts / Every 6th Weekend)

POSITION SUMMARY:

Utilizing a collaborative process, the care manager will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual’s health needs, using communication and available resources to promote quality, cost-effective outcomes.  The care manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the patient and the reimbursement source.

Position: RN Care Manager

Department: 7E / Care Management

Schedule: 40 Hours (Days / 4 10hr shifts / Every 6th Weekend)

ESSENTIAL RESPONSIBILITIES / DUTIES:

The care manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources.  Specific functions within this role include:

Assessment  - The care manager will collect in-depth information about a person’s situation and functioning to identify individual needs in order to develop a comprehensive care management plan that will address those needs.

Planning – The care manager will determine specific objectives, goals, and actions as identified through the assessment process.  The plan should be action oriented and time specific.

Implementation – The care manager will execute specific intervention that will lead to accomplishing the goals established in the care management plan.

Coordination – The care manager will organize, integrate, and modify the resources necessary to accomplish the goals established in the care management plan.

Monitoring – The care manager will gather sufficient information from all relevant sources in order to determine the effectiveness of the care management plan.

Evaluation – At appropriate and repeated intervals, the care manager will determine the plan’s effectiveness in reaching desired outcomes and goals.  This process might lead to a modification or change in the care management plan in its entirety or in any of its component parts.

Conduct a thorough and objective evaluation of the client’s current status including physical, psychosocial, environmental, financial, and health status expectation. As a client advocate, seek authorization for care management from the recipient of services (designee). Coordinates/facilitates patient care progression throughout the continuum.

• Works collaboratively and maintains active communication with physicians, nursing, and other members of the multidisciplinary care team to effect timely, appropriate patient management.

• Ensures appropriate clinical pathway assignment by staff nurses

• Addresses/resolves system problems impeding diagnostic or treatment progress.

• Proactively identifies and resolves delays and obstacles to discharge.

• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.

• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.

• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated caseload; monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis:

  Completion and reporting of diagnostic testing

  Completion of treatment plan and discharge plan

  Modification of plan of care, as necessary, to meet the ongoing needs of the patient

  Communication to 3rd party payers and other relevant information to the care team

  Assignment of appropriate levels of care

  Completion of all required documentation in TQ screens and patient records

Maintain communication and collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting. Completes utilization management and quality screening for assigned patients.

• Applies approved utilization acuity criteria to monitor appropriateness of admissions and continued stays and documents findings based on department standards.

• Identifies at-risk populations using approved screening tool and follows established reporting procedures

• Monitors length of stay (LOS) and ancillary resource use on an ongoing basis.  Takes actions to achieve continuous improvement in both areas.

• Assess resource utilization and cost management; the diagnosis, past an