Care Manager - Inpatient

DUTIES:

The RN Inpatient Care Manager coordinates the care and services of selected member populations to facilitate a safe and timely transition to the next appropriate level of care. Clinically assesses plans implements coordinates monitors and evaluates options and services to meet an individuals health needs. Partners with the healthcare team to ensure all aspects of the patients needs clinical psychosocial and financial are adequately addressed to manage the patients timely progression of care and safe transition from acute care. Promotes effective utilization and monitors of health care resources. Collaborates with the interdisciplinary team to build a comprehensive case management plan to achieve optimal clinical and resource utilization outcomes.

ESSENTIAL DUTIES:

Develops Case Management Plan: Reviews clinical findings and diagnostic reports to maintain a comprehensive understanding of the patients current plan of care. Correlates the medical record findings with patient assessment findings and works with physicians to develop a comprehensive case management plan of care.

Refers High Risk Patients to Social Services: Using specific criteria identifies high risk patients who potentially require psychosocial intervention and refers the patient to the social worker.

Implements Actions to Prevent Readmissions: Conducts patient assessments and intervenes to proactively prevent readmissions; evaluates those who are readmitted to identify causes of the readmission and implements strategies to prevent future readmission.

Develops and Implements Transition of Care Plan: Develops and documents a discharge/transition plan through collaboration with the interdisciplinary team. Ensures that activities to facilitate and coordinate the plan are being implemented and that the plan is continuously modified to meet any patients changing needs.

Monitors and Escalates Financial Management Issues: Communicates with the healthcare team and patient/caregiver regarding any issues related to payer or financial issues that may negatively influence the patients postacute care plan.

Facilitates Patient Progression: Monitors hospitalized patients length of stay (LOS) actively participates and contributes to Care Rounds proactively works with the clinical care team to meet expected length of stay and clinical targets/indicators and proposes solutions to address barriers to discharge to the healthcare team to ensure an efficient and effective transition plan of care.

Coordinates Transitions of Care: Actively communicates with patients families physicians care team members and the Utilization Review Nurse to facilitate coordination of clinical activities to achieve a seamless transition from one level of care to another across the continuum.

Maintains knowledge of Federal State and other regulatory agency rules and regulations including The Joint Commission CMS Medicare including but not limited to knowledge of CMS rules regarding Observation status the 2 Midnight Rule and Medicare Inpatient Only Procedures.

Provides education and resources relevant to the effective progression of care utilization of services appropriate level of care and safe patient transition to the patient/family and health care team.

Identifies potential risk management and/or quality issues and works with the healthcare team to resolve such issues or refer them through the Chain of Command structure to the appropriate resource/committee.

REQUIRED SKILLS & EXPERIENCE:

Excellent communication negotiation and conflict resolution skills.

Data and computer skills.

Knowledge of relevant and state regulatory standards related to Case Management.

Rapid cycle change or clinical performance improvement expertise.

Prior clinical experience in care and management of hospitalized patients.

PREFERRED SKILLS & EXPERIENCE:

Experience in acute care case management preferred.

Case management training from a professional Case Management organization preferred.