What are the responsibilities and job description for the RN- Case Manager (FT) position at Highland District Hospital?
Department: Case Management
Reports to: Director of Nursing
FLSA Code: Exempt
Position Summary:
The Case Manager coordinates the care and service of selected patient populations across the continuum. Works collaboratively with interdisciplinary team both internal and external to the organization to improve patient care through effective utilization and monitoring of health care resources and assumes a leadership role to achieve desired clinical, financial and resource outcomes. Skills needed include excellent written/verbal communication skills, well-rounded critical thinking skills, creative problems skills, creative problems solving, proficient organization and planning. Must have the ability to tolerate frequent interruptions and demanding workload. Knowledge of funding resources, services, clinical standards, and outcomes is crucial. Must be able to perform multiple tasks simultaneously.
Position Accountabilities:
Reports to: Director of Nursing
FLSA Code: Exempt
Position Summary:
The Case Manager coordinates the care and service of selected patient populations across the continuum. Works collaboratively with interdisciplinary team both internal and external to the organization to improve patient care through effective utilization and monitoring of health care resources and assumes a leadership role to achieve desired clinical, financial and resource outcomes. Skills needed include excellent written/verbal communication skills, well-rounded critical thinking skills, creative problems skills, creative problems solving, proficient organization and planning. Must have the ability to tolerate frequent interruptions and demanding workload. Knowledge of funding resources, services, clinical standards, and outcomes is crucial. Must be able to perform multiple tasks simultaneously.
Position Accountabilities:
- Contributes to the development of a goal-directed age-appropriate plan of care through an interdisciplinary team process that is prioritized and based on determined medical diagnosis, patient needs and expected patient outcomes.
- Comprehensively assess patients’ goals as well as their biophysical, psychosocial, environmental, economic/financial and discharge planning needs.
- Procures services and resources, serving as advocate for patients and families.
- Continuum of care responsibilities will require interacting with patients and providers in a variety of settings such as; home, physician offices, ambulatory services – where ever is the most appropriate setting to meet patient needs.
- Communicates patient needs to appropriate professionals, i.e., social worker, clinical pharmacist, diabetes educator, dietitian etc. and follow up.
- Advocates for the patient, family, physician and facility to obtain benefits from insurance carriers and others that provide financial assistance for patients.
- On a concurrent basis, assess the appropriateness and timeless of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues and documentation completeness. Report and documents variances.
- Works in collaboration with Social Workers with primary responsibilities related to family dynamics, relationships, adjust problem and complicated community referrals.
- Review all admissions within one working day (24 hours) from the time of admission determining the necessity and appropriateness of hospitalization, using inter-qual criteria. Assigns a tentative length of stay to cases deemed appropriate for an acute care facility, according to guidelines contained in the Utilization Management Plan.
- Review medical records for documentation completeness.
- Performs hospital wide concurrent reviews every third day and more frequently if needed.
- Communicates with physicians and care team when screening criteria is not met for inpatient treatment or additional documentation may be needed to justify continued hospitalization.
- Coordinates, facilitates and documents discharge planning activities through collaboration with interdisciplinary team. Follow up with patient and family, physician and care team from admission through discharge.
- Communicates continually with patients and families, physicians, care team and third party payers to facilitate coordination of clinical activities and to enhance the effect of a seamless transition from one level of care to another across the continuum.
- Maintains and documents third party payer authorizations, via initial telephonic or faxed clinical review to insurance case managers as requested. Complete continued stay reviews as indicated. Communicates outcomes with business office via the patient account message log.
- Communicates with patients and families to ensure understanding of third party payer guidelines and to arrange referrals.
- Seeks out information and resources and uses creative problem solving for complex discharge planning, quality care and utilization issues. Explores new resources when the opportunities for the patient are absent or in short supply.
- Analysis and evaluation of outcomes of case management to provide continuous improvement to patient care process. Maintain ongoing focus on strategies to reduce length of stay and utilization of hospital resources. Assists in the identification and resolution of barriers to care.
- Identifies and monitors delays in care or service and reports findings to the Manager of Case Management/Vice President of Nursing.
- Participates in the development, implementation, evaluation and ongoing initiatives to improve quality, continuity and cost effectiveness.
- Works collaboratively with other departments and services to define study areas of inefficiency and participates in improvement projects.
- Studies information available to remain abreast of reimbursement modalities, community resources, review systems, clinical and legal issues that affect patient and providers of care.
- Serves as a resource and provides education to patients, physicians and professional staff on levels of care, quality of care issues and regulatory concerns.
- Services will be guided by ethical principles respecting the autonomy, dignity, privacy and the rights of the individuals.
- Orients and supports new staff.
- Responsible for abiding by and adhering to all HDH Corporate Compliance Program initiatives and standards.
- Responsible for compliance with HDH safety standards, policies and procedures.
- Highland District Hospital is committed to serving our community by quality healthcare in an atmosphere of safety, compassion and excellence. It is the responsibility of all employees to interact with patients, visitors, and/or co-workers with compassion, dignity, and respect. Employees are to maintain positive behaviors, approaches and attitudes and commitment to interpersonal service. Each employee is to serve as a role model for the organization’s Customer Service initiative; A-I-D-E-T; Acknowledge – Introduce – Duration – Explanation – Thank-you; proactively promoting teamwork and a collaborative culture.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills of personnel so classified.
Position Qualifications:
Education – Required: Associates Degree in Nursing and current RN license in the State of Ohio.
Education – Preferred: Bachelor’s or Master’s Degree in Nursing.
Minimum Experience: Three years of practice experience in Nursing.
Preferred Experience: Five years of practice experience in Nursing. Previous Case Management experience.
Competencies Required: Demonstrates advanced communication interpersonal skills. Excellent assessment and counseling skills, thorough knowledge of area resources and criteria for using them, excellent writing skills, good problem-solving skills, leadership skills. Ability to relate positively with all customers. Demonstrate time management skills, ability to work under pressure, ability to use wide range of interpersonal techniques and intervention modalities. Requires ability to deal with high level of stress, frequent interruptions, and a consistent workload, with accompanying deadlines. Success Factors: Working knowledge of Medicare, Medicaid, Social Security, and entitlement programs.
Position Qualifications:
Education – Required: Associates Degree in Nursing and current RN license in the State of Ohio.
Education – Preferred: Bachelor’s or Master’s Degree in Nursing.
Minimum Experience: Three years of practice experience in Nursing.
Preferred Experience: Five years of practice experience in Nursing. Previous Case Management experience.
Competencies Required: Demonstrates advanced communication interpersonal skills. Excellent assessment and counseling skills, thorough knowledge of area resources and criteria for using them, excellent writing skills, good problem-solving skills, leadership skills. Ability to relate positively with all customers. Demonstrate time management skills, ability to work under pressure, ability to use wide range of interpersonal techniques and intervention modalities. Requires ability to deal with high level of stress, frequent interruptions, and a consistent workload, with accompanying deadlines. Success Factors: Working knowledge of Medicare, Medicaid, Social Security, and entitlement programs.
Why join the HDH team?
Highland District Hospital is a critical access designated, 25-bed acute care facility. We currently employ more than 400 people and benefit from the services of community volunteers. Our medical staff includes over 100 physicians and 15 mid-level providers, representing over 25 specialties and subspecialties. While we are a community-centered hospital, we are also known for our technology and sophisticated healthcare services. Our service area includes over 65,000 residents from Highland County and surrounding counties.
Highland District Hospital is a critical access designated, 25-bed acute care facility. We currently employ more than 400 people and benefit from the services of community volunteers. Our medical staff includes over 100 physicians and 15 mid-level providers, representing over 25 specialties and subspecialties. While we are a community-centered hospital, we are also known for our technology and sophisticated healthcare services. Our service area includes over 65,000 residents from Highland County and surrounding counties.
At Highland District Hospital we strive to be caring people serving our community by providing exceptional, accessible, quality healthcare in an atmosphere of safety, compassion, and excellence.
Our values provide the framework for fulfilling our mission and vision.
- Quality
- Teamwork/Collaboration
- Integrity
- Patient-First Mind Set
- Compassion
At HDH we are always focused on doing what is best for those we serve and committed to providing a safe, effective, and efficient environment which promotes healing and growth.
Benefits Available:
- Competitive Salary
- Cafeteria Discounts/Employee Ordering Options
- Health, Dental and Vision Insurance
- Company Paid Life Insurance
- Generous Paid Time Off
- OPERS and Ohio Deferred Compensation
- Full-time, Part-time, and PRN schedules available
- Professional Development and Educational Assistance Opportunities
- Loan Forgiveness Program
- Employee Assistance Program
- Employee Recognition Programs
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