Registered Nurse Case Management
: Job Details :

Job DescriptionServes as liaison between the patient and facility/physician. Ensures a continuum of quality patient care throughout hospitalization and oversees provisions for patient's discharge. Assesses, plans, oversees and evaluates the appropriateness of care throughout admission and hospitalization of the patient.Job Responsibility* * Facilitates patient management throughout hospitalization.* Participates in patient management rounds and patient centered meetings.* Identifies potential delays and resolves issues with appropriate departments.* Identifies appropriate utilization of Social Work Services and makes referrals when appropriate.* Confers with physician regarding referrals for Physical Therapy, nutrition, speech and swallow.* * Serves as an in-patient liaison - planning, assessing, implementing and evaluating patient in collaboration with the health care team.* Serves as a resource to the health care team regarding quality, utilization of clinical resources, payer, and reimbursement issues.* Works with on-site screeners in transitioning patients to appropriate post discharge settings.* Collaborates with payers, providing all necessary clinical documentation for the maximization of benefits.* Serves as a liaison to patient, family, admitting, primary care physician, health care team, and hospital departments.* Collaborates with and provides feedback to the primary care physician and multidisciplinary team regarding patient's status with regard to length of stay, utilization of resources and discharge status.* * Provides support to the in-patient health care team as well as to patient and family regarding all aspects of admission, hospitalization and discharge plan.* Involves patient and/or family in discussion and planning for anticipated need for care following discharge.* Ensures patient and/or family are given information regarding their choices regarding transferring the patient to another level of care according to regulatory standards.* * Performs concurrent utilization management using Interqual criteria.* Conducts chart review for appropriateness of admission and continued length of stay.* Contacts and interacts with third party payers to obtain approval of hospital days, pre-certification and post-discharge eligibility in relation to clinical course.* Ensures compliance with current state, federal, and third party payer regulations.* Identifies patients for Alternate Level Care (ALC) care list and notifies appropriate health team members.* Communicates with insurance companies and physicians regarding utilization issues.* Utilizes important message from Medicare (IMM) when appropriate.* Ensures managed care reviews are up to date and accurately reflect patient's clinical progress and acute needs.* * Participates in the quality management of patient care outcomes.* Submits data to management regarding case management and/or quality initiatives.* Participates in data collection regarding patient's length of stay, utilization of clinical resources, IPRO citations including appropriate recommendations and re-admission within 30 days.* * Initiates appropriate discharge planning as supported by initial assessment at time of admission.* Reviews patient's chart.* Assesses each patient physically, psychosocially and financially.* Assesses patient's support system to facilitate appropriate discharge to community.* Substantiates, with the physician, the need for home care services.* Coordinates procurement of any supplies, equipment or home lab work needed by patient to evaluate discharge.* Arranges for post-hospital transportation, when indicated.* Interacts and coordinates with community agencies, families, vendors facilities and institutions to facilitate patient discharge.* * Documents the case management process in the medical record.* Completes and documents a psychosocial assessment on the patient.* Documents on-going processes of patients' hospitalization.* Documents finalized discharge plan and disposition.* Completes applicable areas of the Patients Discharge Instruction Sheet and the Patient Transfer Sheet.* Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile of the patient.* Ensures case management sheet is current and accurate.* Performs related duties, as required.* ADA Essential FunctionsJob Qualification* Bachelor's Degree in Nursing, required.* Current license to practice as a Registered Professional Nurse in New York State.* Case Management Certification, preferred.* Minimum of one (1) year related experience, required. Experience in case management and clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred.* Keeps abreast of developments in the field and serves as a resource to other staff.* Additional Salary DetailThe salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).