Location: St. Joseph Medical Center
Posted Date: 1/29/2021
Under the direction of the Director of Case Management, coordinates patient’s care from admission, through hospitalization, to post-discharge follow-up with emphasis on collaborative relationships with patients and families, clinical nurses, physicians, social workers and other health care team members to best meet the patient’s physical, emotional, and spiritual needs. Specifically, the Case Manager uses a problem solving process that includes assessment, problem identification, goal definition, plan development, evaluation and revision of the plan to achieve optimum patient outcomes.
DUTIES AND RESPONSIBILITIES
Service Consistently supports and communicates the Mission, Vision, and Values of St. Joseph Medical Center. Upholds the Standards of Conduct and Corporate Compliance. Adheres to all Steward Healthcare policies on Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI) People Incorporates the patient’s physiological, psychological, cultural, developmental and spiritual needs into the plan of care. Consistently follows patient care, and facility guidelines and procedures in performance. Directs support personnel in implementing patient’s plan of care, provides supervision and guidance, and evaluates effectiveness of the delegated tasks. Collaborates with inter and intraprofessional colleagues to ensure quality outcomes. Quality: Completes annual education requirements. Maintains competency, as evidenced by completion of competency validation requirements. Promotes a culture of patient safety which results in the identification and reduction of unsafe practices. Uses nursing process to provide all levels of patient care Uses professional judgment and critical thinking to prepare, prioritize, and execute the patient’s plan of care consistent with patient assessment data, physicians’ treatment plans, and professional standards of care. Demonstrates leadership skills including recognition and acceptance of accountability and responsibility for duties and functions within the scope of the practice of the RN; collaboration with other team members towards problem resolution; precise and appropriate verbal and written communication; and behaviors consistent with the role of the professional nurse. Implements measures to prevent exposure to infectious pathogens and communicable conditions. Identifies risks and hazards to patients through various risk assessments, with actions taken to mitigate patient harm. Promotes a high reliability culture of safety by examining structures and processes inculcating the five tenets of safety. Reviews patient’s medical records to collect data pertaining to diagnoses and major procedures performed, evaluates appropriateness of admission, observation and length of stay, and completes required forms. Performs concurrent reviews of admissions to determine medical necessity for admission, observation and continued stays. Refers those that do not meet criteria to the Medical Director, Case Management. Performs concurrent reviews for the appropriateness of resource consumption and refers any over or under utilization to the Medical Director, Case Management. Reviews specific incidents and utilization problems with Physician Advisor such as extended hospital stays, complications with care, and patients waiting for placement. Participates in Medical Staff department meetings and review teams, as appropriate, in order to provide input regarding incidents, prolonged hospital stays, delays in treatment, quality issues or discharge disposition problems. Communicates with physicians as patient’s condition warrants, evaluates the physical status and psychosocial adaptation to hospital environment, monitors variances from the Critical Path/Care Plan and collaborates with other members of the health care team to ensure appropriate interventions are implemented. Conducts ongoing utilization review for compliance with approved third-party treatment plan and ensures necessary interventions. Communicates with payor’s regarding clinical updates and the need for continued hospitalization. Identifies high-risk patient and non-patient situations and facilitates problem-solving process with interdisciplinary team as needed. Assesses each patient on admission for discharge planning and educational needs, plans the patient’s care and ensures that patient family teaching is complete. Sets an example to all staff in their daily activities. Listen to and honor patient and family perspectives and choices. Acknowledge the patient’s and family’s knowledge, values, beliefs, and cultural backgrounds to ensure they are incorporated into the planning and delivery of care. Communicate and share complete and unbiased information with the patients and families in ways that are affirming and useful. Ensure that patients and families receive timely, complete, and accurate information to effectively participate in care and decisionmaking. Encourage and support patients and families in participating in care and decision making at the level they choose. Collaborate with patients, families, healthcare practitioners, and healthcare leaders in policy and program development, implementation and evaluation in facility design, in professional education, as well as delivery of care. Affirms that decisions made that will impact families and direct patient care requires patient and family representation as part of the multidisciplinary approach. Encourage the concept that “just culture” should prevail. Other duties as assigned. Growth: Maintains competency and knowledge of current standards of practice, trends, and developments. Enhances the patient experience by fostering a positive relationship with customers. Contributes to improving patient satisfaction results. Finance: Promotes stewardship of hospital resources while ensuring quality patient care. MINIMUM
KNOWLEDGE, SKILLS AND ABILITIES
Associate's Degree in Nursing, Social Work, or related medical field. Licensed as a Registered Nurse accepted by Texas State Board of Nursing to engage in professional nursing or Licensed as a Social Worker provided by the Texas State Board of Social Worker Examiners. Two years experience as a Clinical Nurse, proficient in clinical and technical skills in nursing specialty; leadership and teaching skills in order to gain a full understanding of case management practices and procedures. Minimum of one 3 years experience involving care management/utilization review responsibility in an acute care hospital and/or managed care setting. Must possess a thorough working knowledge of Medicare, Medicaid and managed care utilization review requirements. Must be familiar with federal, state and accreditation standards as they relate to care management and utilization review. Technical, clerical, critical thinking and interpersonal skills relevant to patient care/area. Certification requirements as defined by the certification policy. Able to communicate effectively in English, both verbally and in writing. Technical, critical thinking and interpersonal skills relevant to clinical area in order to effectively communicate with patients and physicians. Ability to speak clearly enabling patients and the like easy comprehension. Ability to write and print legibly. Demonstration of customer focused skills.
Bachelor of Science in Nursing, Master of Science in Nursing or doctorate degree in nursing. National Certification as recognized by the American Nurses Credentialing Center. Bi or Multilingual.
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.