RN Case Manager

Job Description

Overview

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.

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.

EEO/AA/Disability/Veteran

Responsibilities

• 1. Advocacy and Education
• 1.1 Customer Service
• 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.
• 3. Continuity Transition Management
• 3.1 Ensure patient movement along the acute care continuum (Access, Throughput and Transition).
• 4. Financial Management
• 4.1 Acts as a resource for clinical documentation management outcomes oriented.
• 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
• 6. Psychosocial Management
• 6.1 Counseling Support and Referrals: Substance Abuse, ETOH/Drugs, Adult/Child/Domestic/Elder abuse identification and referrals.
• 7. Research & Practice Management
• 7.1 Application of Evidenced Based Practice.
• 8. Utilization Management
• 8.1 Adheres to The Westerly Hospital's 'Utilization Review Plan', State UR Regs, Third Party Payer contractual arrangements.

Qualifications

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