Case Mgr/PRN

A Brief Overview
Responsible for coordinating, implementing, and monitoring patient care plan from admission to post discharge placement. Serves as a constant within a dynamic teaching environment, ensuring continuity of care and facilitating the efficiency in patient care delivery. Functions as a liaison to bridge between medical staff and hospital services and maximize the function of each in the process of health care delivery. Serves as family and patient contact regarding any care or stay issues

What you will do

• Initiates case management review within established policies, procedures and time frames. Works with the physician, nursing/medical staff, and patient/family and community resources to formulate a plan of care that best meets the needs of the patient. Reevaluates plan of care to ensure it continues to be appropriate. * Determines if criteria have been met based on severity of illness and intensity of services documented by the Quality Resource Screener. * Demonstrates effective communication methods and skills, using lines of authority appropriately to ensure continuity of care. * Demonstrates knowledge and technical, interpersonal skills necessary to provide services, maintain clinical competency and meet age-specific patient needs within the unit
• Communicates with physician daily and conducts rounds within nursing/patient care units to observe, intervene, and evaluate: implementation of care plan, patients' anxieties, needs, staff questions, performance and reinforcements. * Provides clinical assessments and ensures patient's plans are initiated, reviewed, updated and documented in compliance with established standards and practices. * Serves as liaison between physicians, hospital staff, and other agencies to ensure plans of care are coordinated and issues are being resolved in a timely manner. Serves as a patient advocate to resolve concerns or complaints. * Collaborates with physician(s) to ensure that patient centered care core measures and the medication reconciliation sheet are documented. * Coordinates and ensures patient care protocols are followed such as pneumonia, congestive heart failure, stroke and orthopedic standing orders to ensure compliance with intervention requirements. * Reviews forms and ensures proper authorization/certification/signatures to facilitate patient care, including: * authorization/certification for patients undergoing surgery, procedures or diagnostics. * physician's signature on applicable documents (i.e. insurance forms, FMLA forms, disability forms, and home health referral). * authorization for outside medical purchased services.
• Confers and works collaboratively with medical/nursing, other members of the health care team, patient/family and community resources regarding all aspects of patient needs (i.e., patient admission/discharge of/transfer process, discharge planning, referrals, coordinating exams/therapy/rehab, requisitions supplies, obtains medical records, etc.) in a customer responsive and courteous manner, in compliance with iRESPECT Standards and promoting patient/customer satisfaction to coordinate and implement case managements services, to obtain information; answers inquiries and resolve problems regarding quality, appropriateness and/or efficiency of patient care.
• Reviews and reports patients with Length of Stay (LOS) greater than ten (10) days to Director to monitor for appropriateness of acute care based on intensity of service and severity of illness.
• Identifies the patient's insurance network provider(s) for the coordination of discharge planning with the applicable social worker for durable medical equipment (DME), home health services, home infusion, skilled/care rehabilitation facility and transportation services to provide a continuity of care.
• Provides data for research and administrative support for case management operations, special projects and studies. * Collects and records clinical data to identify trends in case management, quality/resource management and identify trends and sources of variances, to measure, evaluate and improve the effectiveness, appropriateness and efficiency of patient care. * Provides statistical analysis of data. * Follows-up as needed.
• Provides documentation and utilizes computer to enter and retrieve medical/patient information; generate statistics, computations, tables or charts within established timeframes. Provides clear, concise, timely written documentation and updates information and computer data as required. Maintains confidentially of all information in accordance with hospital, HIPAA, compliance and other regulatory requirements.
• Prepares and maintains required reports, records, and files for operational, administrative and compliance purposes. Utilizes computer and information systems to enter format and retrieve data, generate statistics, computations, tables, charts and graphs.
• Maintains professional credentials and education necessary to keep abreast and maintain a current knowledge of clinical/theoretical/case management principles, concepts and techniques, best practices and current trends. Attends continuing education, staff development, and mandatory programs.
• Participates in staff training and performance improvement activities and utilizes the results of the quality of care activities to initiate changes in practices. Participates in orientation of medical staff, residents and students to promote an understanding of hospital policies and procedures.

Qualifications

• Bachelor's Degree Or equivalent experience in Nursing Required and
• Education, training or experience to work with the neonatal, adolescent, adult and/or geriatric patient population as assignment dictates. Required
• RN - Registered Nurse - State Licensure and/or Compact State Licensure Registered Nurse licensure to work in state of TN Upon Hire Required and
• CPR - Cardiac Pulmonary Resuscitation Upon Hire Required or
• BLS certification Upon Hire Required
• Minimum 3 years experience Three (3) years clinical nursing experience in an acute care hospital, ambulatory care setting and/or managed care organization; case management experience Preferred

Physical Demands

• Standing - Constantly
• Walking - Constantly
• Sitting - Rarely
• Lifting - Frequently
• Carrying - Frequently
• Pushing - Occasionally
• Pulling - Occasionally
• Climbing - Occasionally
• Balancing - Occasionally
• Stooping - Frequently
• Kneeling - Frequently
• Crouching - Frequently
• Crawling - Occasionally
• Reaching - Frequently
• Handling - Frequently
• Grasping - Frequently
• Feeling - Constantly
• Talking - Constantly
• Hearing - Constantly
• Repetitive Motions - Constantly
• Eye/Hand/Foot Coordination - Constantly

Regional One Health is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.