Case Manager, RN

Job Description

Job Description

Description :

A Case Manager is responsible for the planning, performance, and documentation of the essential case management activities of assessment, planning, implementation, coordination, monitoring and evaluation relative to patient care situations for the identified hospital outpatient, inpatient, and skilled care residents. The scope of the Case Manager’s role spans the continuum of care from pre-admission to post-discharge ensuring the appropriate level of care, type of health, medical, financial, legal, and psychosocial care services to meet the broad spectrum of needs of the patient and / or resident.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Supports and promotes an environment conducive with the Mission, Vision, and Values of the hospital.
• Delivers nursing care according to the standards of care defined within the Illinois Nurse Practice Act
• Assessment : Collect and document in-depth information on the patient’s situation. Assess patient’s health, medical, legal, and psychosocial needs for services through contact with the patient, community or professional caregivers, family and other support systems and medical record review, to develop a case management plan. Reassess ongoing need for services. Communicate / interact with patients and families / support systems, as well as others in the healthcare system such as, physicians, third party payers, community resources / agencies, the multidisciplinary team, and other hospital departments to meet the holistic needs of the patient or resident.
• Planning : Determine objectives, goals, and actions to meet patient identified needs, including desired outcomes with set timeframes utilizing interventions appropriated for pediatric, adolescent, adult and geriatric patients. Document discharge planning in medical records and on Case Management work sheets.
• Implementation : Execute specified case management interventions to accomplish goals in the plan
• Coordination : Organize, secure, integrate and modify resources necessary to accomplish goal in the plan. Communicate needed resources to physicians and service organizations.
• Monitor : Collect ongoing information from all sources concerning the plan’s interventions to determine the plan’s effectiveness. Coordinate multi-disciplinary team meetings.
• Evaluation : periodically determine the plans effectiveness in meeting the desired outcome and goals and modify the plan as indicated.
• Apply case management function across :
• Processes and relationships - interpersonal interviews / communication and relationships, documenting cases, fostering clinical critical thinking of care and plans and relaying input to multidisciplinary team / physicians.
• Healthcare Management – medical case management and assessment of acute and chronic illnesses / disabilities and ethical areas
• Community Resources – coordinate transition through appropriate levels of care such outpatient to inpatient to skilled to long term care or home with home health or hospice, as well as other support services. Provide education of benefits and coverage of public programs (Medicare, Medicaid, SSI and SSDI)
• Service Delivery – Interact with managed care companies for patients. Implement cost-containment strategies. Develop quality protocol practice guidelines for diagnoses. Conduct UR activities and management. Interact with Business Office, HIM and Ancillary service departments.
• Psychosocial intervention - address family dynamics with cultural issues, psychosocial areas for patients and residents. Provide medically related social services for patients in the outpatient and inpatient setting, and Swing Bed / Transitional Care Unit. Assist patients and residents with Advanced Directives. Make and coordinate referrals.
• Rehabilitation Case Management - Assist and provide education to patients on disability compensation, worker’s compensation, disability, etc. Evaluate needs to make transfer referrals for inpatient and / or skilled residents for inpatient rehab to address functional, vocational, and life care planning needs.
• Coordinate care, implement strategies, and conduct prospective, concurrent, and retrospective reviews based on established evidence-based guidelines.
• Participate in improvement teams to change processes and systems to achieve seamless care delivery.
• Conduct follow-up evaluation of care across continuum of care and patient satisfaction identifying clinical, operational, financial, or social issues impacting patient outcomes.
• Makes clinical decisions and sets priorities related to workload management based on clinical knowledge and individual patient needs.
• Maintain confidentiality of all patients, hospital, or physician related information
• Maintain orderly condition of assigned work area.
• Is knowledgeable of general hospital and unit specific policies and procedures.
• Other duties may be assigned and are subject to change with or without prior notice.

OTHER RESPONSIBILITIES

The above statements describe the general nature and level of work being performed. They are not intended to be an exhaustive list of all duties, and indeed additional responsibilities may be assigned, as required, by Hillsboro Health.)

SUPERVISORY RESPONSIBILITIES

None

Requirements :

EDUCATION AND / OR EXPERIENCE

CERTIFICATES, LICENSES, REGISTRATIONS

PHYSICAL DEMANDS

WORK ENVIRONMENT

CORPORATE COMPLIANCE

Receives training and / or attends necessary meetings to meet the criteria as outlined in Hillsboro Health’s Corporate Compliance Plan and Code of Conduct. Understands the responsibilities related to compliance and knows how to contact the Corporate Compliance Officer should there be any instance of question or concern regarding fraud and / or abuse.

BENEFITS

Please use the link below to visit our website for a list of benefits offered.

Staff Benefits - Hillsboro Health