Nurse Case Manager
Nurse Case Manager
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
JOB SUMMARY:
Provides Care Coordination and discharge planning services for all inpatients accessing care through the Univ. of Md. Upper Chesapeake Health. Completes psychosocial assessments assists with treatment planning monitors patient progress facilitates patient and family meetings and coordinates and implements discharge services. Screens patients to identify anticipated needs interacts with patients and families so that a safe and timely care plan is achieved. Coordinates and implements discharge and postacute services for inpatient caseload. Position requires coverage on holidays and on back up call system on weekends. May interact with clients or customers ranging in age from newborn to geriatric.
Care Coordination:
- Screen patients to identify needs and prioritize caseload to identify high risk and rising risk patients.
- Coordinate with the interdisciplinary team to develop revise (if necessary due to change in patient progress) and implement appropriate discharge interventions to ensure safety and care coordination.
- Accepts responsibility for patients Transitions of Care coordinating provisions for discharge to including followup appointments home health community services transportation etc. in order to maintain continuity of care on identified high risk patients.
- Communicate with CRM manager any pertinent findings causing a delay in care coordination safe d/c planning and/or LOS.
Assessment:
- Completes a thorough assessment with patients history including medical physical social emotional psychological and financial needs that will assist the care team in developing a care plan.
- Identifies barriers to health care both in social and medical need that focuses on the prevention of readmissions.
- Promotes patient selfmanagement educating patients on disease medication access to care selfcare support to improve clinical outcomes and increase patient selfefficacy.
- Provide and review the appropriate community resources/services with the patient/family.
- Maintain accurate timely documentation of actions/services in the appropriate EMR and data collection.
Rounds: (Patient Model of Care Palliative Care and longstay rounds)
- Actively participate in rounds to ensure continuity of care is communicated with other disciplines and to ensure a reduction in LOS.
- Have knowledge of patient plan of care.
- Document appropriately.
- Report patterns of noncompliance.
- Consults regularly with the inpatient provider PCP Director and Supervisor and other team members to ensure that the transition plan remains relevant appropriate and responsive to changing patient status and/or goal
- Establish an effective and appropriate means of communicating and collaborating with physicians team members payers and administrators to ensure safe and efficient services.
- Identify need for arrange and facilitate peer consultation/health team meeting/family conference when necessary to advance coordination of complex services/resources and medical and/or social issues.
- Develops and maintains collaborative relationships with the postacute representatives to ensure safe and confidential and transfer is timely.
- Participates in identifying and achieving the departments PI initiatives and goals. Reports and documents process and safety issues in the Events Tracking system.
- Orients new team members and students.
- Maintain professional development best practices and continuing education for care coordination.
- Assist with special projects and other duties as assigned
Qualifications :
MINIMUM KNOWLEDGE SKILLS AND ABILITIES:
Education & Training:
- Currently licensed as an RN in the State of Maryland. Associates degree or diploma in Nursing required. Completion of a Bachelors of Science degree in Nursing preferred.
- Work Orientation & Experience: Acute care nursing experience required. Inpatient or Outpatient care experience required. Case Management experience preferred.
Skills & Abilities:
- Demonstrate skill in a) clinical case management; b) performing complete assessments; c) effective critical thinking skills both written and oral; and d) age appropriate interpersonal interactions (patients may range from newborn to geriatric adult.)
- Ability to a) communicate and collaborate effectively with both internal and external customers (colleagues Medical Staff liaisons and patient/family); b) assess adapt and calmly respond to changing and/or crisis environment; c) make independent decisions consistent with current policies procedures and ethical standards; d) prioritize work assignments and manage time effectively to complete duties; and e) assist in data analysis.
Additional Information :
All your information will be kept confidential according to EEO guidelines.
Compensation:
- Pay Range: $37.92$53.59
- Other Compensation (if applicable): N/A
- Review theUMMS Benefits Guide
Remote Work :
No
Employment Type :
Parttime
Employment Type
Part-time
