RN Case Manager
Coordinates and monitors the multidisciplinary provision of comprehensive quality patient care throughout the continuum for patients with identified complex case types. Facilitates achievement of expected outcomes within an appropriate length of stay. Acts as an expert resource to internal and external staff regarding the continuum of care, efficient use of resources, best practice protocols, quality indicators and improvements, and regulatory requirements. Provides for a smooth transition of care between inpatient and outpatient environments. Educates patients and families about their hospital and post-hospital course. Continuously monitors and measures progress of interventions and outcomes. Performs patient care review activities including monitoring and correcting of patient status, documentation for medical necessity of admission and continued hospitalization, and concurrent reviews.
Education:As required by licensure.BSN preferred.
Experience:This position requires extensive clinical knowledge of diseases, work up procedures, treatment and prognosis, resource management, facilitation and coordination of a team approach and hospital discharge procedures. Minimum 3 years clinical nursing experience. Minimum 1 year of relevant experience in one or more of the following areas required, 3 years preferred:
Discharge Planning for arrangements of rehab, home health, hospice, skilled nursing home, long term acute care hospital facilities; accessing community resources; team collaboration in identification of patient’s inpatient and after care needs with an understanding of resource and utilization management.
Case Management with familiarity with community resources and levels of care.
Coordination of care for best practices for diverse patient populations with an understanding of diseases and treatments.
Licensure/Certification:Current applicable state RN licensure. Certified Case Manager preferred.
Demonstrated knowledge of case management principles.
Excellent organization, oral and written communication skills for effective interaction with patients, patient’s families, physicians, multi-disciplinary team members, and representatives from insurance plans.
Knowledge of discharge/transition planning, health care reimbursement, utilization review processes and Medicare admission status/classification levels.
Knowledge of level of care criteria (InterQual).
Knowledge of regulatory issues.
Ability to adhere to and implement regulations in an effective manner. Must serve as a resource to all team members regarding regulatory issues.
Knowledge of computers and experienced in use of electronic medical chart and office systems.
Supports and models the Legacy Preferred Employee Profile.