Case Manager

Summary:
As a member of a multidisciplinary team collaborates with physicians nurses and medical directors to coordinate facilitate and expedite patient care services across the continuum from pre-admission to discharge and continuing care. As a member of that team shares responsibility for the implementation of the discharge plan; ensures efficient and effective delivery of patient care services through appropriate utilization of healthcare resources. All functions are carried out in consideration of the aging processes human development stages cultural patterns and patient choice in each step of the care process.

 

Responsibilities:
Demonstrates understanding of Hospital�s Mission Vision and Values.
Demonstrates understanding of job description performance expectations and competency assessment plan.
Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to our customer service standards.
Complies with department and hospital policies and procedures.
- Reviews policies and procedures
- Reviews Employee Handbook
Completes mandatory education.
- Hospital-wide
- Department-specific
- Job-specific

Participates in departmental and/or interdepartmental quality improvement activities as requested: i.e. OpX teams weekly long LOS reviews collaborative care rounds
In accordance with established standards and criteria assesses appropriateness of admission utilizing licensed level of care criteria or compliance with Medicare regulations 
Collaborates with physicians to ensure placement of the patient in the appropriate level of care including observation or other non-inpatient care settings.
Coordinates the length of stay with the physician care team and patient.
Ensures team is informed of insurance qualifiers that may affect the discharge plan.

KEY FUNCTIONS

Initiates the discharge plan according to departmental policy
Ensures all applicable elements of the discharge plan are communicated to the patient and/or family.
Monitors the cost-effective use of resources without compromising patient need and the quality of care provided.
Facilitates and expedites care across the continuum.
Supports the team in analyzing variances in length of stay to minimize delays and maximize the efficient use of resources.
Coordinates and updates the discharge plan in collaboration with members of the multidisciplinary team in accordance with the patient�s clinical course and continuing care needs and choices.
Prior to planned discharge ensures that the patient and family have received education on his/her hospital course length of stay third party requirements and available alternative settings for care
Provides clinical information to third party payers for certification or authorization of inpatient services as well as any other details necessary to support the discharge plan.
Coordinates the collection and transmittal of pertinent clinical information required to complete arrangements for post-discharge and/or placement.
Serves as a resource to the team regarding payer information requirements and targeted lengths of stay.
Communicates to the team excess day and denial information as well as other relevant third party issues in order to be more proactive in managing the episode of illness.
Ensures appropriate information is shared in a timely manner with other health care providers involved within and outside the hospital community.
Collaborates with the multidisciplinary team to identify patients and/or families with complex psycho-social non-medical discharge planning issues including continuing care needs such as provided by home health services hospice or nursing home placement.
Coordinates the post-discharge follow-up activities as appropriate.
Collects and analyzes data collected on clinical indicators to communicate and facilitate opportunities for improvement in clinical quality process improvement and resource utilization.
Participates in ongoing education-related professional activities and affiliations to maintain an advanced level of knowledge in the area of patient care services third party payer and managed care requirements and case management.

Collaborates with discharge planning team and nursing leadership to affect quality patient outcomes.

 

Other information:
Qualifications:
Registered Nurse with Bachelor�s degree in Nursing or equivalent experience licensed to practice as a Registered Nurse in the State of Rhode Island.
Minimum of three years related clinical experience demonstrating recent knowledge of case management utilization review (UR) RI UR Law quality assurance discharge planning third party payor regulations and community health.
Experience should demonstrate high level of interpersonal skills both oral and written analytical skills leadership abilities and effectiveness within a team environment.  

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

 

Location: Newport Hospital USA:RI:Newport

 

Work Type: Part Time

 

Shift: 2

 

Union: Non-Union


Work Schedule: 3:00P-11:30P Every other weekend rotating holidays