Minimum Education:Will consider RN to BSN candidates with experience
License/Cert Required:Not Indicated
Minimum Experience:2 Years
Specialty Type:Case Management
Under general supervision, provides utilization management, care coordination, and discharge planning for an assigned patient case load. This role is patient focused, outcome-oriented, and based on general and specialty professional standards, and functions within a multidisciplinary practice model. The scope of the role extends beyond University of Maryland System boundaries and includes authority and accountability to intervene on the behalf of identified patients wherever care is required.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1. Assesses the needs of individual patients within an assigned case load for care coordination, discharge planning, and utilization management services Facilitates early referral to physical therapy, occupational therapy, social work, risk management, patient advocacy, post-acute services, and quality management when needed. Refers clinical issues and lapses in standards of care to appropriate parties.
2. Creates case management care plans for assigned patients. Comprehensively assesses patients’ requirements for services. Extensively assesses patients’ organizational, and payer needs with regard to meeting clinical and financial goals, and patient/provider satisfaction.
3. Facilitates multi-disciplinary collaboration. Collaborates with colleague case managers in providing coordination of care. Works with a multi-disciplinary team to develop a treatment plan, including contingency plans. Contributes to problem solving within the team through communication, collaboration, data collection, obtaining consensus, and evaluating outcomes of treatment options.
4. Implements strategies for case management care plans. A. Intervenes on behalf of the patient and organization to achieve above stated goals B. Informs patients and families about services and alternatives and assists them in making informed care decisions. C. Manages implementation of the treatment plan across the in-patient and out-patient continuum. D. Facilitates the discharge planning process to assure timely referral, discharge, and access to community services. E. Negotiates funding options from payers.
5. Continuously monitors and evaluates services and outcomes for assigned patients. Determines extent to which clinical, satisfaction, and financial goals are met. A. Creates summaries for review with the multi-disciplinary team and for outcomes reporting to executive management, utilization management and department heads. B. Demonstrates value of program through quantitative evidence of cost-reducing, quality enhancing interventions on the behalf of patients and the organization.
Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.
1. Takes action to correct observed risks to patient safety.
2. Reports adverse events and near misses to appropriate management authority.
3. Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.
Education and Experience
1. Licensure as a Registered Nurse in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required. Bachelor’s degree and certification as case manager are both preferred.
2. One year of experience in case management and knowledge of payer mechanisms and clinical utilization management is preferred. Two years experience in acute care required, four years clinical nursing experience preferred. Additional experience in home health, ambulatory care, and/or occupational health is preferred.
3. Four years clinical experience which includes demonstrated effectiveness in coordinating care for a broad range of high risk and complex patients is required. Experience in acute care as well as home health, ambulatory care, and/or occupational health is preferred.
Knowledge, Skills and Abilities
1. Knowledge of managed care, discharge planning, utilization and case management is required.
2. Highly effective verbal and written skills are required.
3. Strong communication skills, self confidence and experience dealing physicians required.
4. Excellent analytical and team building skills, as well as the ability to prioritize and work independently is required.
5. Must possess the ability to work collaboratively with other disciplines.
6. Ability to work with Hospital/Case Management related software programs required.
7. Ability to demonstrate knowledge and skills necessary to provide care appropriate to the patient population(s) served. Ability to demonstrate knowledge of the principles of growth and development over the life span and ability to assess data reflective of the patient's requirements relative to his or her population-specific and age specific needs.