RN Case Manager

Description

Position Title: Case Manager/Swing bed lead

Department: Nursing

Supervisor’s Title: Acute Care Manager

Position Summary: Coordinate’s care of the patient from pre-hospitalization through discharge. Assesses, plans, implements, and evaluates the needs of patients to develop and facilitate an appropriate plan of care and discharge plan. Oversees the needs and successful delivery of quality patient care on the swing bed unit. Collaborates with physicians, nursing, insurance payers, patient and significant others who have an ongoing caring relationship with the patient.

I. Principle Functions and Responsibilities:

A. Case Management:

Performs intake assessment (e.g., living arrangements prior to admission, level of functioning, physical care prior to admission, contact person, discharge information, lists provided to patient/family, patient choices made, and initial plan) on patient within 24 hours of admission (patients meeting screening criteria). Determines medical necessity, appropriateness of admission, continuing stay and level of care using a combination of clinical information, InterQual clinical criteria, and third-party information. Intervenes when determinations are not in alignment with clinical information, clinical criteria, or third-party payer requirements to resolve the situation. Document’s information in the clinical record. Identify clinical indicator and social indicators which identify a potential need for transition/discharge planning.

1. Advocates for the patient and family to ensure involvement in care and treatment decisions.
2. Meets daily with care team and rounds on patients as appropriate to ensure continuity of care, appropriateness of care and patient satisfaction with care and services.
3. Actively contributes to, participates in, and follows through on interventions identified in care coordination, shift report and patient rounds.
4. Works as the primary liaison between the patient/family, healthcare team and third-party payer.
5. Collaborates with medical staff to ensure medical necessity is met and appropriate placement achieved. Makes referrals to secondary level reviewer, as needed.
6. Facilitates communication and coordination between members of the healthcare team, involving the patient in the decision-making process to minimize fragmentation in the services.
7. Identifies high-risk patients and creates a collaborative plan to address their unique needs.
8. Documents all Case Management activities for patients in electronic health record.
9. Identifies opportunities for quality improvement and works with team members to implement changes.
10. Keeps patient informed of progress and provides information related to disease progression. Prepares individualized patient education packet and reviews contents with patient and family during stay in collaboration with nursing staff as appropriate.
11. Educates patient and family on all aspects of patient’s hospitalization, following the healthcare plan and continuing care.

B. Discharge Planning:

1. Assesses the patient and family for continuing care and education needs.
2. Collaborates and communicates with patients/families related to reimbursement issues and to create a discharge plan.
3. Uses clinical knowledge to address actual/potential barriers to discharge.

Case Manager/Swing bed lead

1. Documents discharge planning in an ongoing manner.
2. Coordinates and facilitates transitions in care to ensure continuity and patient safety including communication with providers for follow up care.
3. Communicates patient education needs with care team.

C. Utilization Review:

1. Performs Utilization Review activities by assessing for the appropriate utilization of resources through communication with members of the healthcare team to facilitate reimbursement and review of documentation.
2. Collaborates with the third-party payers for required notifications of admission and concurrent review as requested.
3. Consults with other departments, as appropriate, to collaborate in patient care and performance improvement activities.

D. Transitional Care (Swing bed)

1. Oversees the delivery of patient care in the Transitional Care unit.
2. Assesses, plans, implements, and evaluates patient care outcomes, consults with other specialists as required and adjusts nursing care processes as indicated to ensure optimal care.
3. Maintains established departmental policies and procedures, objectives, quality improvement program, safety, environmental and infection control standards.
4. Supervises the non-licensed staff on the swing bed unit including Physical Therapy, Occupational Therapy, Speech Therapy, and Activities Coordinator.
5. Manages Transitional Care/Swing Bed service line growth including facilitation and collaboration of incoming transfers from outside health organizations, and onsite visits to surrounding health systems as needed.
6. Understands and follows the Idaho Nurse Practice Act, the ANA Code of Ethics, and the ANA Social Policy Statement.
7. Consults and communicates with the Acute Care manager and keeps the Acute Care manager informed of both clinical and non-clinical needs, staff issues, and all patient care activities.
8. Communicates effectively with physicians and associate providers both verbally and in writing.
9. Maintains awareness of the ongoing Quality Improvement studies within the unit. Consults with Quality Management as needed.
10. Maintains a safe, comfortable, and therapeutic environment for patients/families, and visitors in accordance with hospital standards.
11. Assists other members of the nursing team and/or other disciplines as necessary to ensure continuity of care.
12. Enhances professional growth and development through participation in educational programs, current literature, in-service trainings, and workshops.
13. Attends meetings as required.
14. Maintain positive and effective relations with coworkers, other departments, patients, family members, and visitors.
15. Provides input to supervisor regarding employee performance and annual competency to assist with yearly evaluations.
16. Performs other related duties as assigned or requested.

Requirements

I. Position Qualifications/Requirement:

1. Education: Bachelor’s degree in nursing and RN license in good standing in Idaho
2. Preferred Education: Master’s degree in nursing
3. Preferred Minimum Experience and Skills:
4. Three years of acute care nursing
5. One-year acute care case management
6. Able to communicate effectively in English, both verbally and in writing.
7. BLS within one month of hire and on-going.
8. Interpersonal skills necessary to instruct/comfort patients/families; to maintaineffective communication/contact with healthcare team members.
9. Analytical skills necessary to prioritize workload and prepare discharge care plans, implement effective discharge care, and collaborate with Social Services to develop solutions to problems concerning patient’s psychosocial environment.
10. Basic computer knowledge including Microsoft Outlook, Microsoft Word and Internet
11. Ability to learn Computer software programs including Cerner, Policy Manager, OneSource

II. Physical Requirements:

1. Prolonged sitting, data entry/charting
2. Frequent walking throughout the campus
3. Frequent, prolonged standing
4. Occasional patient care activities: lifting, moving, transferring, ambulating or wheelchair mobility of patients on various care units.

V. Working Conditions and Expectations:

1. Direct patient care exposure to patient environment
2. Adheres to dress code, appearance is neat and clean.
3. Completes annual education requirements.
4. Maintains patient confidentiality.
5. Reports to work on time and as scheduled, completes work within designated time.
6. Wear’s identification while on duty, uses time keeping system correctly.
7. Completes education/competencies as required.
8. Attends annual review and department in-services, as scheduled.
9. Represents the organization in a positive and professional manner.
10. Actively participates in performance improvement and continuous quality improvement

(CQI) activities.

1. Communicates the mission, ethics, and goals of the facility, as well as the focus statement of the department.