RN, Registered Nurse - Case Manager
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The Case Manager facilitates clinically appropriate and fiscally responsible patient care through communication with the treating physician and all other members of the healthcare team, while incorporating Utilization Review/Discharge Planning interventions and working in close cooperation with hospital management. The Case Manager assesses and identifies the patient's physical and psychosocial needs and determines, in conjunction with established protocols and input from the treating physician, the health care services and venue of care appropriate for the patient. The Case Manager manages the patient's treatment prospectively through the admission process, concurrently through on-going case management while the patient is an inpatient in one or more venues of care and retrospectively through review of individual cases and identification of trends and patterns. This position requires the full understanding and active participation in fulfilling the Mission of CHRISTUS St. Frances Cabrini Hospital. It is expected that the associate demonstrate behavior consistent with the Core Values. The associate shall support the CHRISTUS St. Frances Cabrini's strategic plan and the goals and direction of their Performance Improvement Plan (PIP).
Directs, coordinates, and supervises the care delivered to designated caseloads of specific age groups and case-types of patients.
Receives referrals for case management services from patient, family, treating or consulting physician, nursing staff and/or other members of the healthcare team.
Reviews and assesses the patient's physical, spiritual, functional, clinical and psychosocial needs and assists the treatment team in coordination of plan of care.
Coordinates and affects the delivery of medically appropriate care consistent with established medical practice protocols, guidelines and/or clinical pathways through consultation with the treating physician, other members of the healthcare team, medical staff/hospital administrative committees and hospital management.
Coordinates and affects the delivery of fiscally responsible healthcare services consistent with reimbursement mechanisms, including the delivery of care within targeted length of stay criteria for uncomplicated, diagnosis-related categories of medical conditions.
Identifies, monitors, and assesses variances in lengths of stay through observation and structured studies, and identifies and resolves causative factors in consultation with medical staff and hospital administration.
Identifies, monitors, and assesses variances in lengths of stay through observation and structured studies, and identifies and resoles causative factors in consultation with medical staff and hospital administration.
Identifies, monitors and assesses variances in cost of care through observation and structured studies, in close cooperation with the business office, nursing, therapies and ancillary departments, and identifies and resolves such causative factors in cooperation with that Department, the treating physician, other members of the healthcare team and hospital management committee(s).
Proactively communicates with and educates treating and consulting physicians and other healthcare providers to increase awareness of practice treatment patterns and venues of care that promote the delivery of appropriate, quality medical treatment within established lengths of stay.
Identifies the anticipated discharge date, and collaborates with the interdisciplinary team while coordinating post hospital care with the treating physician.
Plans and participates in case management, multidisciplinary team conferences through an integrated and analytical decision-making process and documents in care manager appropriately.
Initiates and contributes to modifications/changes in nurse and physician practice pattern to achieve quality of care, patient satisfaction and appropriate use of resources.
Maintains current knowledge of national standards of practice, JCAHO and criteria appropriate to medical and nursing specialty.
Assesses and ensures compliance with current nursing specialty standards for specific age groups identified, planning, implementing and evaluating changes where appropriate.
Implement plans and strategies to alter practice patterns where appropriate.
Serves as communication link to physicians for comprehensive documentation to improve the content and clarity of the medical record to ensure the severity of illness.
Maintains professional competence through participation in appropriate professional societies and groups.
Maximizes positive financial outcomes for his/her designated case-types.
Collaborates with medical records and physicians to ensure appropriate reimbursement by thorough documentation for accurate coding.
Minimize risk through monitoring for potential compensatory events and liability control
Documents all review activity via HBOC/Star Navigator System.
Consistent application of SI/IS criteria and validates appropriateness of admission or continued stay.
Reviews all cases regarding pre-certification, concurrent and retro, review in assigned areas and initiates appropriate appeals.
Participates in coaching processes to improve documentation and optimize coding.
Communicates length-of-stay and other resource consumption goals to the clinical team.
Remains current as to reimbursement and other trends in commercial insurance, Medicare and Medicaid.
Optimizes efficiency of operational systems through continuous quality improvement.
Assesses efficiency and cost effectiveness of interdepartmental systems.
Identifies and analyzes problems/inefficiencies in interdepartmental operations and reports them through the Quality Indicator Program in Case Management.
Plans, implements and evaluates strategies to correct/improve problems/inefficiencies identifies.
Participates in Performance Improvement teams, health care systems/physician advisory committees, or continued education to improve personal performance and/or performance of Case Management team.
Communicates advance knowledge and skills related to nursing and the management of care to patient, families, nurses, physicians and other health care providers.
Assesses patient/family teaching needs and ensures the provision and evaluation of teaching and learning as appropriate.
Documents education in the Care Manager as guided by policy and procedure.
Other related duties as required.
Displays professionalism through good work habits as observed in all encounters.
Demonstrates an ability to adapt to changing priorities in the organization, utilizes time effectively in response to work load, staffing levels, and fluctuations in patient census.
Accepts work assignments.
Performs work in an accurate, neat, and consistent manner.
Keeps current with all standards, policies and procedures of CHRISTUS St. Frances Cabrini and acts as a resource to other staff members when necessary.
Promotes and supports the CHRISTUS St. Frances Cabrini policies, procedures, and programs; assists in changes of medical center policies, procedures, and programs as needed.
Shares responsibilities, offering assistance to co-workers and responds to requests; supports teamwork by assisting others when needed.
Keeps in close communication with supervisory staff as appropriate.
Demonstrates an ability to communicate effectively. Always follow appropriate channels of communication.
Knowledge of professional nursing theory and practice. Working knowledge of various reimbursement mechanisms, insurance carriers, and third party payer requirements. Knowledge of the ANA/CMSA Code of Ethics. Demonstrated ability to operate a personal computer. Possession of critical thinking skills and the ability to analyze and present data. Ability to maintain effective working relationships with fellow employees, patient, families and physicians. Ability to effectively manage patient cases