CASE MANAGER

Summary of Essential Functions

• Encompasses the process of case management practice in partnership with the medical staff and members of the clinical team accountable for outcomes of selected patient populations.
• Accountable to the patient and the community and is responsible for facilitating the patient’s safe, cost efficient, progression-of-care throughout the entire episode of acute care and assuring the patient’s timely and seamless transition back to the community.

Educational Requirements

• High School diploma or equivalent
• Associate degree or Bachelor’s Degree in Nursing
• Must be able to communicate effectively in English, both verbally and in writing.

Licenses and Certifications

• Registered Nurse with current Texas license and in good standing with governing board in Texas
• Nationally recognized certification in Case Management preferred.
• Current certification in Basic Life Support (BLS) preferred.
• Current CPI training preferred.

Knowledge/Skills/Abilities

• At least 5 years recent hospital experience and knowledge of CMSA’s case management standards of practice.
• High degree of interpersonal and communication skills
• Vocal, visual, auditory, physical, and manual ability to adequately perform clinical psychosocial interventions.
• Must have basic computer knowledge including word processing and navigational skills
• Must be able to demonstrate the ability to work effectively as a healthcare team member and prioritize work.
• Ability to demonstrate proficiency in use and application of all electronic tools
• Must have effective written and verbal communication skills, be a positive relationship builder, ability to effect change, perform critical analysis, plan and organize effectively.

Physical Requirements

• Requires prolonged standing and sitting, along with frequent bending, stooping and stretching.
• May require lifting up to 25 pounds.
• Requires eye-hand coordination and manual dexterity.
• Requires the ability to distinguish letters and symbols, along with normal vision range.

Duties and Responsibilities

• Advocate for patient by assessing that patient healthcare needs are being addressed at the most appropriate level of care. Assesses patient situation by collecting information from patient and family, professional and non-professional caregivers, employers (as appropriate), and health records to identify individual needs to develop a comprehensive progression-of-care management plan that will address those needs.
• Communicates, consults and coordinates with medical advisor as necessary to resolve progression-of-care barriers through appropriate administrative and medical channels. Serve as primary liaison between clinical team. Maintain appropriate documentation on each patient to include specific information of all planning, liaison, and coordination activities. Educates members of the patient’s healthcare team on the appropriate access to, and use of various levels of care. Recognizes and responds appropriately to risk factors. Assess the effectiveness of services and their outcomes in concert with the interdisciplinary team, recommending appropriate plan modifications to assure treatment objectives are met.
• Pro-actively participate as a member of the interdisciplinary clinical team to confirm appropriateness of the treatment plan relative to the patient’s preference, reason for admission, and availability of resources. Actively participate in daily rounding meetings, patient care conferences, and hospitalist/nurses hand-off reports to gather sufficient information to determine the effectiveness of the treatment plan and patient care goals. Identify and record episodes of preventable delays or avoidable days due to failure of progression-of-care processes. Understand and apply federal law regarding the use of HINNs, ABNs, and medical necessity criteria. Assertively collaborate and manage resource utilization while appropriately navigating the patient's movement along the continuum of care.
• Collaborate with nursing and members of the clinical team to provide patient/family education regarding discharge goals that require the team’s expertise (medication administration, transferring to/from a car, oxygen use, etc). Research discharge placement options, when home discharge is not possible, while continuing to focus on patient/family goals, interdisciplinary team recommendations, available payer benefits and private financial considerations which may impact placement.
• Communicates and coordinates with Utilization Review Nurses (URN) for correct bed status confirmation and medical necessity for continued sta