Case Manager - Full Time - Days

Why work for Nebraska Methodist Health System? At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in. Job Summary: Location: Methodist Jennie Edmundson Address: 933 E. Pierce St. - Council Bluffs, IA Work Schedule: Monday through Friday 07:00 to 15:30; rotating weekend and holiday schedule A Case Manager is a professional that ensures a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services is maintained to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost effective outcomes. Ask your recruiter/hiring manager about the following incentives that may be available for this position: • Shift differentials & other financial incentives • Tuition assistance • Academic sponsorship with Methodist College • Free parking Responsibilities: Essential Functions 1. Promotes positive relations when interacting with patients, visitors, families, physicians, customers and co-workers. Greets smiles and makes eye contact. Introduces self by name. Volunteers to help co-workers and other employees. Responds quickly to patients and/or other peoples’ needs. Recognizes and values input from health system personnel. Redirects hospital staff to demonstrate core values to promote a positive work environment. Serves as a role model to promote collaborative relationships. Knows and demonstrates customer complaint management process. Communicates effectively to solve problems at the personal and unit level. Remains calm in difficult situations and effectively diffuses crisis and refers to appropriate supervisory levels as needed. 2. Clinical Care Coordination/Facilitation and Psychosocial management – coordinating multiple aspects of care to ensure the patient progresses. Properly identifies patient’s problems, psychosocial needs, environmental/barriers to care and coordinates the selection of appropriate services. Responds to discharge needs in the Emergency Department (ED). Performs an initial/ongoing assessment of the patient, support system, and environment to determine factors that impact the patient’s ability to maintain the highest level of independence. Properly identifies patient needs. Coordinates care and services provided by the interdisciplinary team to meet the needs of patient and/or family through the episode of illness from pre-hospital/ED to post-hospital care. Provides timely referrals to care team (i.e., Social Work, Rehab, Wound Care, and Diabetes Educator) and provides pertinent clinical information to facilitate discharge/inpatient admission arrangements. Informs patient/family of services available and initiate services that are consistent with patient’s identified needs to maintain the highest level of independence. Effectively communicates patient/family needs and concerns as soon as identified to the physician and interdisciplinary team and assures appropriate utilization of hospital and community resources are offered and arranged. Provide immediate counseling of patients and family and effectively diffuses crisis and refers to appropriate services as needed. 3. Continuity/Transition Management – transitioning of the patient to the appropriate level of care needed. Provides assistance with discharge planning – when needed, identifies appropriate agencies/facilities for patients requiring assistance at home or placement at another level of care. Maintains a level of expertise and current knowledge base on available community resources and services available. Provides and documents a list of agencies available that serve the geographical area requested by the patient. (HHA, SNFs). Discloses to patient/family if the hospital has any financial interest with post hospital agencies. Initiates services that are consistent with the patient’s identified needs by providing referral to appropriate resources as soon as recognized. Effectively communicates with agencies/facilities of the patient needs. Provides access to electronic medical record to agencies/facilities. Completes PASSR for nursing home admissions. Ensures services provided are consistent with the patient’s identified needs. Facilitates the return of patients to their previous facility. 4. Participates in the development of the discharge plan and assesses the effectiveness. Collaborates with physician, interdisciplinary team and patient/family to develop comprehensive, proactive discharge plans for all complex patients. Properly contacts patient/family to assure needs are being met after discharge. Participates in daily huddles/unit rounds and effectively communicates any barriers to discharge with patient/family, physician and interdisciplinary team. Facilitates discharge planning by documenting an accurate picture of patients discharge needs, services offered and any barriers to discharge or plan of care from being implemented or carried out. Collaborates with the interdisciplinary team to ensure barriers are addressed and ensure a safe discharge occurs. 5. Utilization/Financial Management – Managing resource utilization and management. Collaborate with team to avoid unnecessary admission due to social reasons. Recognizes payer source and what criteria insurance companies utilize. Provides daily evaluation of all observation/outpatient surgical patients criteria/guidelines for severity of illness and intensity of service that are potentially going to cross two midnights to ensure appropriateness of admissions/higher level of care needs. (Disease Specific) Communicates appropriate information to providers as requested. Serves as a gatekeeper for admissions. Provide real time evaluation of admission criteria/guidelines and continued stay for severity of illness and intensity of service to ensure appropriateness of admissions/higher level of care needs. Monitor and facilitates appropriateness of tests/procedures, consultations, treatment plans, and resource utilization. Discusses and reviews inquiries with Primary Care physician – including if appropriate asking for documentation of medical necessity of treatments. Anticipates barriers/variances to the delivery of care. Uses critical thinking skills to provide sequencing of care activities to assure quality outcome for patients. Provide appropriate notices to patient after direction of physician advisor to include – HINN 10, 11, 12, Advance Beneficiary Notice of Noncoverage (ABN), IM, nonmedical waiver. 6. Performance & Outcomes Management – monitoring, and, intervening to achieve desired goals and outcomes for both the patient and the hospital. Participates in the development and implementation of community collaboration based on evidence-based practice that includes Methodist Jennie Edmundson Hospital core values, readmission efforts, decreasing length of stay efforts, and improving communication with the community. Assures that the core values, readmission, LOS, communication efforts are a community process and that the guidelines are well researched. Knowledgeable of community care efforts to decrease readmissions, appropriate ED utilization and admissions. Makes appropriate referrals to community partners through Unite Us. Participate in community meetings to meet the needs of the community effort that benefit the patient and/or family through the episode of illness from pre-hospital to post-hospital care. Utilizes Unite Us to document community resources and barriers of high-risk patients. Completes readmission worksheet and initiates readmission huddle to monitor and identify reasons for readmissions (Disease Specific) Facilitates the Chronic Pain Process and assists physicians in setting up plans of care for high risk or frequently seen patients. Utilizes Chronic Pain policy. Participates in Chemo Huddles to monitor and identify appropriate utilization of resources and care being provided in correct setting. Collaborate with community partners to develop diagnosis-related protocols and standardized-based work. Provides concerns or barriers with community partners so communication will occur as soon as problems or concerns are identified. 7. Advocacy & Education – ensuring the patient has an advocate for needed services and any needed education. Promotes the education of all members of the interdisciplinary team, physicians/office staff, and patient/families. Provides ongoing education based on needs assessment – including use and understanding of admission criteria, issues related to funding, classification and types of admissions, and areas of patient choices and accountability. When current level of care is not appropriate, acting as resource to provider and patient for counsel, education and referral for access to the most appropriate care. Understands the principles of reimbursement as well as processes and procedures for securing authorization of admit status from payers. Is able to educate and explain the rationale for determining admission and continued stay criteria. Communicates issues/trends (positive/negative) to Unit Nurse Manager and Supervisor as needed. Provides patient/family education and counseling about existing health problems and related care. Participates in new employee and student orientation. Willingly performs other duties as assigned. 8. Research & Practice Development – Identifying practice improvements and using evidence based data to influence needed practice changes. Utilizes data bases from internal and external sources to demonstrate the effectiveness of case management in promoting quality patient outcomes and high patient satisfaction as well as efficient use of resources. Participates in timely and accurate data collection and assures that the data is reliable and valid measures will be obtained. (i.e. InterQual, Unite Us, Nebraska Health Information Initiative (NEHII), productivity studies, readmissions etc.) Assists in using the data collected to identify opportunities for improvement in hospital goals and outcomes. Participates in Performance Improvement process. Schedule: Monday through Friday 07:00 to 15:30; rotating weekend and holiday schedule Job Description: Job Requirements Education Graduate of accredited Nursing Program required. Associate Degree in Nursing (ADN), Diploma, Bachelor of Science in Nursing (BSN) preferred. Experience 3-5 years current med-surg experience. 3-5 years relevant clinical experience, ED experience preferred, for Care Management department. Discharge Planning, Case Management and Utilization Review experience preferred. Requires knowledge of case management principles, utilization review process, nursing principles, community resources, and adult education principles. Requires skills in data collection, operating office equipment, and communication. Requires the ability to communicate effectively, develop collaborative relationships with a variety of professionals, and use critical thinking skills to problem solve. License/Certifications Current American Heart Association or American Red Cross Basic Life Support (BLS) strongly preferred at time of hire, required within 3 months of hire. Current valid Registered Nurse (RN) License, valid compact multistate license, or a temporary permit while awaiting licensure required. Skills/Knowledge/Abilities Excellent communication skills, verbal and written. Demonstrates ability to maintain favorable relationships with physicians and health system personnel. Is self-directed and able to multi-task and prioritize work assignments. Able to deal with resistance and complex situations. Functions as an educator to physicians and health system personnel. Must be objective and logical. Demonstrates critical thinking skills. Ability to foster an attitude of teamwork and trust. Physical Requirements Weight Demands Medium Work - Exerting up to 50 pounds of force. Physical Activity Occasionally Performed (1%-33%): Climbing Crawling Kneeling Sitting Frequently Performed (34%-66%): Balancing Carrying Crouching Distinguish colors Keyboarding/typing Lifting Pulling/Pushing Repetitive Motions Standing Stooping/bending Twisting Walking Constantly Performed (67%-100%): Grasping Hearing Reaching Seeing/Visual Speaking/talking Job Hazards Not Related: - Electrical Shock/Static Rare (1-33%): Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc) Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means) Occasionally (34%-66%): Chemical agents (Toxic, Corrosive, Flammable, Latex) Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF) Explosives (pressurized gas) Frequent (67%-100%): Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment) Equipment/Machinery/Tools Mechanical moving parts/vibrations About Methodist: Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission. Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law. At Methodist Health System, we focus on providing exceptional care to the communities we serve and the people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. If you join our organization, you will have the opportunity to excel in your field, use the latest technologies, learn from the best and work as a team. You’ll have the opportunity to make a difference through The Meaning of Care.