Outpatient High Risk Case Manager

SUMMARY:

Under the general supervision of the system Manager of Case Management Special Programs or Director of Case Management, the Outpatient High Risk Case Manager performs all the functions of a Case Manager Registered Nurse within the Department of Case Management. Collaborates with the clinical healthcare team across the patient care continuum and participates in the oversight of the progress of complex patients. The Outpatient High Risk Case Manager will work with patients in the community referred from various settings throughout Brown University Health system. When applicable, they will collaborate with the inpatient case management team to provide a smooth transition post acute discharge. They will meet with the patients in the community as needed and help the patients collaborate with community providers to maximize their supports and resources outside of the hospital. Collects data and facilitates clinical quality improvement (CQI) to enhance the quality and cost effectiveness of patient care and prevent readmissions.
Goal: To provide patients a smooth transition to the next level of care post discharge from the acute care setting. The Outpatient Case Management team will follow patients after discharge to ensure proper follow up, including appointments, home care services, supplies, and long-term planning.
Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

Instill Trust and Value Differences
Patient and Community Focus and Collaborate

RESPONSIBILITIES:

Performs all duties of the Case Manager and demonstrates expertise in clinical specialty.
The Outpatient High Risk Case Manager will follow patients who utilize the Brown University Health system, including but not limited to The Miriam Hospital, Rhode Island Hospital, and Newport Hospital.
Follows a complex patient population and targets interventions in conjunction with the healthcare team.
Provides care plan direction for the advancement of a patient care delivery system which supports managed care strategies and decreases readmission risk. Acts as a change agent by identifying opportunities to improve patient flow and reduce service delays through problem resolution and follow-up.
Collects data on all readmitted patients and incorporates findings into post-acute plan of care in collaboration with members of the healthcare team. Research includes follow-up calls to skilled nursing facilities, home health care agencies and acute rehabilitation facilities.
Promotes patient satisfaction by facilitating patient participation in education programs.
Supports all through-put and capacity management activities for the Brown University Health System.
Provides case management consultation within and outside the hospital.
Assists with Community Paramedicine program data and collaborates with the Brown University Health and community agencies providing services.
Assists with Case Management Staff orientation as needed.
Maintains and enhances professional expertise through educational activities.
Adheres to Brown University Health, Hospital, and departmental policies and procedures to maintain a safe environment of care and compliance with all laws, regulations, and standards.
Perform other duties as assigned.

MINIMUM QUALIFICATIONS:

Licensure as Registered Nurse in the State of Rhode Island by the Rhode Island Board of Nursing or licensure as a Registered Nurse in accordance with the Nurse Licensure Compact agreement of the National Council of State Boards of Nursing; and Licensure as Registered Nurse in the State of Massachusetts Board of Registration in Nursing.

EDUCATION

Bachelor's Degree in Nursing from an accredited National League of Nursing (NLN) program with current license to practice as a Registered Nurse in the State of Rhode Island and State of Massachusetts is required

Certification by a recognized national organization in case management is preferred; or certification to be obtained within eighteen months of hire.

EXPERIENCE
Three to five years of clinical case management experience preferred.
Demonstrated knowledge and skills necessary to provide patient care and to develop or administer care management services with consideration of stages of human development and cultural patterns.
Analytical skills necessary to evaluate patients, programs, and procedures.
Demonstrated ability to exercise independent judgement. Refers specific complex