Registered Nurse (RN)- Case Management
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POST DATE 9/13/2016
END DATE 11/15/2016
JOB DESCRIPTIONJob Code: 00187-4731
Days (rotating weekends)
The RN Case Manager is responsible for the appropriate allocation of Valley Regional Medical Center resources through facilitating a quality driven, cost effective plan of care. The Case Manager collaborates internally and externally with patients, families and significant others, clinicians and third party payers to assess, develop, implement and evaluate a plan of care based on identified needs and available resources.
The Case Manger implements patient safety activities to include:
Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered
Demonstrates knowledge of the occurrence reporting system: uses Meditech system to document and report potential patient safety issues.
Adheres to established guidelines for reporting a significant medical error or an unanticipated outcome in the patient s care which results in patient harm
Attends in-service presentations and completes mandatory education as required
The Case Manager demonstrates a commitment to teamwork and cooperation. He/She supports organizational goals by providing quality customer service and participating in performance improvement efforts. The Case Manager will apply the mission, vision, and value statements of Valley Regional Medical Center in the fulfillment of Case Management functions and comply with hospital policies and procedures.
Registered Nurse with current Texas License, Bachelor s Degree preferred
Two years of clinical nursing experience required, Case Management or Utilization Review experience preferred
American Heart Association (Health Care Provider)BLS required
Case Management or Utilization Review certification, preferred
Demonstrated ability to establish and maintain collaborative and effective working relationships
Demonstrated ability to communicate effectively in oral, written and electronic form
Demonstrated ability to critical thinking, analytical and decision-making skills, and negotiation
Demonstrated ability to perform basic word processing and spreadsheet functions
Ability to collect, interpret and report data, as required
Ability to take call evening, nights and weekends
JOB SPECIFIC PERFORMANCE COMPETENCIES:
Duties & Responsibilities:
Consistently follows & documents Case Management Review Process as outlined in the Interqual book.
Using Interqual criteria monitors and documents all admissions, observation stays and continued stays for specific medical necessity.
Plans appropriate interventions, reassesses the patient & modifies the plan of care as necessary.
Consistently documents plan of care & discharge needs in the Case Management section of the medical record within one business day of referral/admission.
Educates nurses, physicians & ancillary staff on appropriate criteria, length of stay and resource consumption.
Accurately assesses transfer eligibility and assists physician with transfer when clinically meets next Level of Care.
Maintains current knowledge of regulatory rules and guidelines for Medicare, Medicaid and contracted Managed Care Organizations.
Consistently and accurately follows processes and documentation guidelines set forth by HCA Gulf Coast Division.
Consistently and accurately collects data for statistical information etc. and prepares reports as requested.
Consistently consults with charge nurse and accurately identifies Medicare patients potentially discharging in the next two days. Consistently and accurately passes this information on to the Case Management Assistant prior to 9:30am.
Last Edited: 07/19/2016