Case Manager

Westerly, RI
Jun 18, 2019

Share:

Job Description

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

EEO/AA/Disability/Veteran

Summary:
Case Management (CM) is an organized program that relies upon professional, clinical and/or nursing expertise and critical thinking skills to ensure safe, appropriate and fiscally responsible Access, Throughput and Transition within and across the continuum of care. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources balanced with the patient?s right to self-determination. The CM functions include utilization review, patient advocacy, resource management, continuum of care management, transitions of care and clinical documentation management {refer to Scope of Practice, TWH UR Plan}. Staff will provide information and guidance to the patient and/or family promoting improved self-management, and enhanced patient-practitioner communication. A hospital case manager is an autonomous role that will, coordinate, negotiate and collaborate with the patient/family and the interdisciplinary team (both internal and external) in a patient and family centered model of care. Staff will ensure compliance with the hospital's UR Plan, demonstrating expertise in denial prevention/management. Staff will actively participation in the UR Committee. The hospital Case Manager will be responsible for coordinating all interventions/outcomes provided by the Care Management Team.

Responsibilities:
  • 1. Advocacy and Education
  • 1.1. Customer Service
  • 1.2. Serves as a resource and provides education to patients, physicians and professional staff on levels of care, quality of care issues and regulatory requirements
  • 1.3. 'Transitions of Care'; Patient/family self care management thru education, advocacy, support and communication (completion and transmission of all State, Federal, and/or 'other' type forms) across settings.
  • 1.4. Ethics and/or Risk Management identification and referral. Serves on hospital committees as appropriate.
  • 2. Clinical Care Coordination/Facilitation
  • 2.1. Plan of Care and Outcomes Management. Facilitate coordination, communication and collaboration on behalf of the patient/family, physician and payer to achieve goals and maximize positive patient health outcomes. Patient Integration; ensure that each patient is the center around which all care decisions, plans of care and interventions are focused.
  • 2.2. Patient/Family Care Conferences
  • 2.3. Interdisciplinary Care Communication and Coordination. Actively participates in Interdisciplinary Patient Care Rounds.
  • 2.4. Clinical Resource Management; outcomes oriented, data driven, minimizes post acute fixes
  • 3. Continuity Transition Management
  • 3.1. Ensure patient movement along the acute care continuum (Access, Throughput and Transition).
  • 3.2. Discharge Planning; serve as a consultant and educator to patient and family to explore the most appropriate setting to safely meet identified needs. Ensure patient/family are informed of service providers (i.e. HHA's, DME's, Hospice and long term care facilities) capable of providing for their post acute care needs, and all real or potential fees associated with such services. Ensure that patient 'choice' is offered and obtained and documented.
  • 3.3. Advance Directives, Palliative/End of Life Care Referrals
  • 3.4. Community Resource Coordination (outpatient Cardio-pulmonary rehab, meals, elder/mental health services, 'other')
  • 4. Financial Management
  • 4.1. Acts as a resource for clinical documentation management outcomes oriented.
  • 4.2. Healthcare clinical resource management - clinical cost efficiency
  • 4.3. Coordination of patient benefits. Financial assistance referrrals.
  • 4.4. Appeals Management. Compliance with Medicare's discharge notice/appeal.
  • 5. Performance & Outcomes Management (Clinical Resource Management)
  • 5.1. Federal, State, Local, Regulatory agency complaince. Actively participate in the hospital's Utilization Review Committee. DNV (IOS 9001), RI UR Regs, patient safety and quality core measures
  • 5.2. Clinical guidelines, evidence based practice
  • 5.3. Quality Improvement Practice Standards
  • 5.4. Organizational Performance Improvement/Management; LOS, Cost per Case, Denial Management
  • 6. Psychosocial Management
  • 6.1. Counseling Support and Referrals: Substance Abuse, ETOH/Drugs, Adult/Child/Domestic/Elder abuse identification and referrals.
  • 6.2. Crisis Intervention; emotional stability, coping, grief and bereavement
  • 6.3. Psychosocial Assessment and Functioning. Completes (or assists in the completion of) Mental Health screens (as mandated by state regulations) for patients transferring to skilled nursing facilities.
  • 6.4. Health Wellness Promotion
  • 7. Research & Practice Management
  • 7.1. Application of Evidenced Based Practice.
  • 7.2. Will monitor and evaluate the effectiveness of case management interventions.
  • 7.3. Work proactively with management to modify practice patterns in an effort to attain a continuous cycle for improvement.
  • 7.4. Case Management Best Practices. Professional standards; collaboration, communication, facilitation, coordination, advocacy, resource management, accountability, professionalism.
  • 8. Utilization Management
  • 8.1. Adheres to The Westerly Hospital's 'Utilization Review Plan', State UR Regs, Third Party Payer contractual arrangements.
  • 8.2. Application of medical necessity; intensity of service, severity of illness and discharge screening criteria. Level of care appropriateness; admission status determination.
  • 8.3. Avoidable day identification and tracking
  • 8.4. Clinical Denial Prevention


    Other information:

    EDUCATION:

    Bachelors Degree (or higher) in the healthcare field preferred Cerification in Case Management desirable.


    EXPERIENCE:

    3-5 years of recent experience in an acute medical/surgical setting. Knowledge of Interqual criteria, utilization management, case management and discharge planning required. Experience in home health, hospice or public health and computer data management preferred. Familiar with community resources and manged care orgainzations required.


    LICENSURE:

    Must hold a valid Rhode Island Nursing License BLS


    SPECIAL_SKILLS:

    ACCOUNTABILITY:

    Critical thinking, teamwork, crative problem solving, self directed, skilled negotiator, Knowledge of current utilization management principles, PRO criteria and standards, discharge planning processes. Commits to continuous learning and strives to improve competence in all areas of practice Advances knowledge of the profession through research and application of best practice. Adheres to professional standards of practice and his/her professional code of ethics.

    COMPLEXITY:

    PHYSICAL_DEMAND:

  • Share:

    Not ready to apply, but interested in working at Yale New Haven Health?

    Join our Talent Network

    Job Info

    Job: 9965

    Department: Case Mgt Social
    Category: Nursing-staff
    Sub Category: CASE MGMT/UTIL REV
    Status: Full Time
    Shift: DAYS
    Hours: 40.00

    Similar Jobs

    General Staff Nurse - LMH ED

    New London, CT
    Nursing-staff

    Cos RN

    Waterford, CT
    Nursing-staff

    General Staff Nurse - 5.4 Cardiac/Pedi

    New London, CT
    Nursing-staff

    School RN

    Waterford, CT
    Nursing-staff

    Registered Nurse Ed

    Westerly, RI
    Nursing-staff

    General Staff Nurse - Hemo

    New London, CT
    Nursing-staff

    General Staff Nurse - LMH ED

    New London, CT
    Nursing-staff

    Registered Nurse Card Cath

    Westerly, RI
    Nursing-staff

    General Staff Nurse - Endo

    New London, CT
    Nursing-staff

    Case Manager

    New London, CT
    Nursing-staff

    RN - Per Diem - Pequot ED

    New London, CT
    Nursing-staff

    RN - Per Diem - 4.1 Neuro

    New London, CT
    Nursing-staff

    Case Manager

    Westerly, RI
    Nursing-staff

    Registered Nurse OR

    Westerly, RI
    Nursing-staff

    Patient Care Mgr - Cancer Ctr

    New London, CT
    Nursing-staff

    General Staff Nurse - Float Pool

    New London, CT
    Nursing-staff

    RN - Med Surg 5.2

    New London, CT
    Nursing-staff

    RN - Per Diem - LDRP

    New London, CT
    Nursing-staff

    General Staff Nurse- 6.2 Med/Surg

    New London, CT
    Nursing-staff

    General Staff Nurse - PD - IV Therapy

    New London, CT
    Nursing-staff

    RN - Per Diem - LM ED

    New London, CT
    Nursing-staff

    Registered Nurse

    Westerly, RI
    Nursing-staff

    RN - Per Diem - NICU

    New London, CT
    Nursing-staff

    Registered Nurse MCU

    Westerly, RI
    Nursing-staff

    Registered Nurse Float

    Westerly, RI
    Nursing-staff