To facilitate the patient's hospitalization from pre-admission through discharge by assessing each patient for discharge needs and coordinating services to meet those needs. Perform utilization reviews in accordance with established Hospital UR Plan.
Screens admissions according to established criteria
Accepts referrals in coordination with other case manager
Coordinates the provision of social services and discharge planning to patients, families and significant others, enabling them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from health care services
Fosters team planning of patient care services
Chairs multidisciplinary team meetings
Performs chart reviews using Interqual criteria
Review of DRG assignments
Completes home care and DME referrals
Provides clinical information to insurance companies upon request
Notifies Infection Control Practitioner of patients admitted with infectious disease
Coordinates the referral of patients and families to appropriate community, social services, residential care and rehab facilities and organizations
Assists patients and families with evaluation and placement in Long Term Care Facilities
Maintains a record in each referred patients chart including an initial assessment and on-going case activity
Provides supportive counseling, information and referral to patients dealing with illness related problems
Provides services to Emergency Room, ambulatory surgery, maternity and out patients upon request
Contacts the Medical Director or UR Physician of UR issues as needed
Develops and maintains harmonious working relationships with other departments: addresses interdepartmental issues
Represents the hospital on assigned hospital committees
Insures staff awareness of services available by maintaining current lists of agencies
Completes assigned competencies annually
Participates in performance improvement activities as directed
Actively participates in Core Measure Process
Completes chart reviews for performance improvement studies
Responsible for insuring patient’s safety and reporting any concerns to the Director of Quality Management
Meets on a regular basis with the Director of Quality Management
Participates in departmental VIP activities
Responsible for participation in and the implementation of the organization's Corporate Compliance Plan into all areas of responsibility
Identifies improvement opportunities so that enhancements in patient care delivery and outcomes can be made
Collects pertinent and timely data and uses it to improve outcomes
Focuses on strategies that result in reducing complication, morbidity, and mortality
Meets with the patient and/or family to ascertain needs and provide and/or arrange for services
Communicates/notifies patient placement issues/concerns to Director of Quality Management
Performs UR reviews as assigned
Maintains a log of insurance company contacts
Optimizes the provision of quality healthcare that meets the interests of consumers, providers and payers
Assists our organization in meeting the standards of regulatory and accrediting agencies.
Participates in implementation of new computer programs
Responsible for understanding and adherence to the Standards/Code of conduct and the Corporate Compliance Plan at St. James Mercy Hospital
Ensures that all educational requirements related to Corporate Compliance are implemented and adhered to as required by the CCP Education Plan
Ability to read, write and interpret documents in English such as safety rules, operating and maintenance instructions and procedure manuals. Ability to read, analyze and interpret common scientific/trade/technical journals. Ability to respond to common inquiries or complaints from customers, or regulatory agencies. Ability to effectively present information to employees, top management, public groups and/or board of directors.
Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals. Ability to calculate figures and amounts such as proportions, percentages, rates and ratios.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to move or transfer patients with an individual effort equal to 50 lbs. Should have a full range of body motion to successfully perform all essential functions of the job, meaning you’ll have to stand, walk, bend, kneel, crouch and reach frequently during a 12 hour shift.
Job Title: Registered Nurse: Case Manager
Status: Per DiemShift: 1st Hours: 8:00 AM - 4:30 PMPay Frequency: Bi-Weekly