Transitional Care Manager (Case Management)

Description

JOB SUMMARY

Under the general direction of the Executive Director of Nursing, the Transitional Care Manager is responsible for oversight of the day-to-day operations of the Transition Care Management (TCM) program. Responsible for managing RN Case Managers. Focuses on patient-centered care planning and advocacy while educating patients and families about home health services and related expectations. This position is accountable for training, auditing, providing team support, and leveraging program data and outcomes. The TCM will lead efforts to develop, implement, evaluate, and iterate Transition Care Management practice standards and will work closely with the clinical team and Nursing Home to assist patients safely, effectively, and efficiently across the continuum of care in accordance with Joint Commission, federal, state, and local guidelines, organizational and departmental policies, and procedures.

STANDARDS OF PERFORMANCE

1. Supervises, trains, evaluates, and assigns related work activities to Case Managers.
2. Coordinates coverage for TCM team including overseeing PTO requests and on-call coverage.
3. Participates in the development and implementation of departmental goals, objectives, policies, and priorities in collaboration with the Executive Director of Nursing.
4. Oversees daily operations of the Transition Care Management (TCM) team.
5. Partners cross-functionally to establish mechanisms to address issues related to TCM tracking, trending, and documentation, and reports trends to the Executive Director of Nursing.
6. Models expert clinical practice, leadership skills, and critical thinking skills to efficiently coordinate and direct patient care, while maximizing the use of resources.
7. Applies creative and innovative approaches to develop and maintain high levels of multi-disciplinary team performance and desired patient outcomes.
8. Coordinates with TCM staff to ensure safe/effective/efficient plans of care are implemented.
9. Conducts chart audits per established policy to ensure documentation standards are met.
10. Communicates openly with the Executive Director of Nursing, providing updates and patient successes.
11. Functions as a SME for Transition Care Management, and related efforts.
12. Meet in person with internal and/or external stakeholders to facilitate team and business priorities/opportunities.
13. Within the Scope of Nursing Practice, the Transitional Care Manager continuously assesses self-knowledge and competencies to ensure job performance.
14. Ensures adherence to proper infection control, OSHA, and safety standards.
15. Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.
16. Facilitation of precertification and payer authorization process.
17. Completes and documents timely clinical reviews based on assessment of medical necessity and documented clinical findings in accordance with hospital policy and payer findings.
18. Communicate with the attending physician regarding appropriateness of patient admissions, resource utilization, and when documentation does not support continued stay. 
19. Demonstrates understanding of medical necessity and intensity of service and incorporates payer requirements into the development of a safe, effective, and timely discharge plan.
20. Assess re-admission risk and socio-economic factors in the creation of a safe and individualized transition plan. 
21. Collaborates with an interdisciplinary team throughout the patient’s stay to reassess and adjust the plan for care progression and transition according to the patient’s clinical condition. 
22. Perform other duties as requested, required, or assigned.

Requirements

Minimum Level of Education: Associate or bachelor’s degree in Nursing required, Master’s in nursing preferred.

Formal Training: Management skills with experience in planning, organizing, implementing, facilitating, interviewing, counseling, and verbal and written communications.  

Licensure, Certification, Registration: Must have and maintain an unencumbered license/Certification as a Registered Nurse with the State of Georgia and have and maintain a BLS CPR certification.

Work Experience: Minimum of Four years’ acute hospital experience as a Registered Nurse and RN Case Management required. Utilization review experience preferred. 

Computer Skills: Intermediate computer literacy with the capability to effectively use Microsoft computer software to include Outlook, Word, Excel, and PowerPoint.