Case Manager RN

Summary

Under the general supervision of the CFO, acts as a patient advocate/case manager to hospital clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes.

Essential Duties and Responsibilities include the following. Interviews senior clients in crisis situations involving social, emotional, financial, marital, health, or other problems to develop background and details of problems.

• Assesses and evaluates cases and prepares and implements treatment and case management plans.
• Counsels senior clients, assisting them to identify and resolve problems and make effective use of resources.
• Works closely with families of patients and provides appropriate clinical services to family members including individual counseling and group work such as family support groups, grievance counseling, caregiver groups, and respite care.
• Maintains working relationships with staff of other agencies and institutions, homes, and facilities, and acts as liaison between clients and agency or institution.
• Assists clients in finding ways of adjusting to patient changes that will allow for a life style as comfortable as the situation will permit.
• Encourages clients to do things for themselves to retain feelings of independence and self-esteem.
• Provides consultation to staff on specific cases involving patients.
• Prepares and maintains written case records, reports, and forms, performs case follow-up and closing, and performs other administrative tasks as required.
• Ensures that health care services are administered with quality, and are cost effective
• Applies review criteria to determine medical necessity for admission and continues stay
• Assist ion the identification of appropriate utilization of resources across the continuum of care
• Participates in quality improvement and evaluation process related to the management of patients care
• Adheres to all policies and procedures documented in the Connally Memorial Medical Center policy and procedure manual
• Other duties as assigned.

Education and/or Experience

Fifth year college or university program certificate; prefers three years Case Management experience but must have at least one year Case Management experience.

Certificates, Licenses, Registrations

Healthcare professional with degree in health science strongly preferred

BSN or MSN preferred

Other Skills and Abilities

Three to five years of acute care hospital experience preferred.

Critical care or emergency department experience highly desirable.

Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking. Knowledge of healthcare financing, community and organizational resources, patient care processes, and data analysis.

Knowledge of utilization management as it relates to third-party payers.

Knowledge of post acute care community resources.

Experience with managed care preferred.

Excellent verbal and written communication skills required.

Demonstrates flexibility via an ability to adapt to changing priorities and regulations.

Basic computer skills required