Case Manager - Quality & Case Management - Per diem
Position Summary: Promotes the development of high quality patient care in the most effective setting, balancing patient/hospital advocacy. Knowledgeable of third party payor issues.
Coordinates patient care across the continuum of care:
• As needed, strives to maximize and mobilize all internal and external resources that facilitate the case management process for all assigned cases
• Documentation always reflects patient plan of past hospital care and if applicable interdisciplinary coordination.
• As needed, provides a nursing assessment within 24-48 hours of patient admission for clinically oriented services focused on mobilizing primary care physician, hospital systems, patient/family and community resources directed towards facilitating a clinically safe and timely discharge
• Identifies problems and gaps in patient care when covering for unit case manager. Suggested interventions, expedited interdisciplinary referrals and ensured diagnostic testing is completed and reported within appropriate timeframe
• Actively participates in patient care conferences as scheduled on nursing units when covering for the unit case manager
• Works collaboratively with medical staff, nursing and other therapeutic disciplines in developing and implementing a patient plan of care while covering for case manager. Follows plan of care initiated by unit case manager. Initiates initial plan of care for new patients assigned.
• Clinically documents patient plan of care, progress, goals, and interventions according to Case Management Department, Federal, and State guidelines.
• Maintains a professional working relationship with Managed Care Organization telephonic and on site reviewers and external reviewing agencies in monitoring course of hospitalization and need for post hospital services according to third party payor guidelines. Returns all calls from managed care organizations occurring on day covering the case.
• Community health care agencies and third party payor utilization review agencies are provided with patient care information through allscripts that is concise, accurate and communicated in a timely manner. All reviews assigned to per diem case manager sent when completed unless review referred for second level review.
Education: Bachelor of Nursing Degree required. Significant Case Management experience considered in lieu of Bachelor degree.
Experience: Three to five years experience acute care nursing experience or one to three years experience in utilization review and/or discharge planning preferred
Certification/Licensure: Current MA RN license