RN Complex Case Manager - PRN (68461)

JOB SUMMARY

Practices with minimum supervision from another licensed professional and is able to perform the following components of case management according to the Case Management Society of America Standards: assessment, facilitating, planning, advocating, , monitoring, evaluation, and outcomes.. In collaboration with all healthcare professionals involved, this position is also able to demonstrate the above components within the following core activities: coordination and service delivery, physical and psychological factors, benefit systems, cost benefit systems, cost benefit analysis, case management concepts and community resources.

The case manager facilitates communication and coordinates between all members of the healthcare team involving the patient and family in the decision-making process in order to minimize the fragmentation of the healthcare delivery system.

The case manager is a leader in effecting change to improve the quality of patient care and reduce the cost of services on a care by care basis.

The case manager understands financial implications of care in todays healthcare environment such as (but not limited to): requirements for prior approval by payer; cases which would benefit from alternative care; analysis of necessary medical services for cost containment; healthcare plans for appropriateness; home health/hospice resources; healthcare delivery systems; DRG system; care mix index; managed care and capitation.

Responsibilities also include facilitating the admission process for non-elective, emergency inpatient admissions and outpatient observation stays; monitoring observation stays at the end of 23 hours for possible inpatient admission or discharge planning; ensuring that all patients are screened against Interqual/Milliman or other appropriate criteria and assist the physician in identifying alternative methods of care when criteria are not met. Works closely with the Physician Advisor on cases that do not meet admission criteria or continued stay criteria. Provides simple discharge planning services, such as Home Health and DME referrals and makes referrals to social workers for complex discharge planning. The case manager and social worker will work in collaboration as a team to ensure timely provision of services. The case manager will be responsible for identifying performance improvement opportunities and assist with data collection. The case manager will assist in program development and implementation for specific programs and plans of patient care such as clinical pathway, population specific and disease management initiatives. The case manager will coordinate the care of an average case load of 25 patients per day.