What are the responsibilities and job description for the Case Manager - RN Per Diem 8 Hour Day Shift position at Memorial Hospital of Gardena?
Position Description
Position Title : RN-Case Manager
Department : Case Management
Reports to :
Case Management Director
Exemption Status : Non-Exempt
Approvals : Effective Date :
8 / 2024
Job Summary :
Under the general supervision of the CM Director the RN Case manager manages clinical resource utilization and documentation affecting reimbursement, acting as a resource to staff and physicians in resource efficiencies and documentation that affects reimbursement. In this position the RN Case manager provides for a planned and systematic process for monitoring and evaluation of all patients, assessing the medical, financial, psychosocial, and physical needs in planning for discharge. Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication.
Essential Functions :
- Reviews clinical information daily on each patient to determine if continued stay is clinically appropriate and if not, discuss the discharge plan with the physician and team
- Identifies all observation patients, reviews status daily using InterQual guidelines, and communicates directly with the attending physician regarding the appropriate level of care of when observation hours may exceed more than 24 hours. Escalates to management on any patient exceeding observation services greater than two midnights.
- Initiates and documents discharge planning assessments within 24 hours of patient admission.
- Coordinates the integration of case management functions into the patient care, discharge and home planning processes. Collaborates with the clinical team, Medical Staff, hospital departments, external service organizations, healthcare facilities, patients, and families / support people to facilitate the transition of the patient from acute care to the discharge setting
- Communicates with physicians daily throughout the patient's hospitalization to develop an effective working relationship, effectively utilize resources, develop discharge plans consistent with the patient's available resources, utilization management issues, and understand barriers related to planning.
- Ensures physician documentation supports medical necessity and level of care for each inpatient day, educates physicians by actively discussing additional documentation needs as identified or based on discharge plans.
- Partner often throughout the shift with the Discharge Planning Coordinator to direct the facilitation of transition / discharge plan to arrange post-acute facility, DME, HH, etc. in a timely manner, preventing avoidable days.
- Enter avoidable days as indicated.
- Leads daily HPIRounds with the purpose to collaborate with members of the health care team in removing barriers to discharge and managing LOS.
- Communicate current patient status, level of care and LOS in huddles and HPIRounds
- Collaborate with other care team members and patient / family to create a safe and effective transition / discharge plan
- Responds timely to case management consults for patients
- Refers patients to SW in a consult as indicated
- Confers with physician for clarification / change of status order when indicated assuring the status order change has been written in the EHR
- Collaborates with CDI in determining the GMLOS to drive length of stay
- Initiates referral to financial counseling for patients needing assistance
- Consults and works with medical staff, nursing, and ancillary staff regarding functional status and needs of the patient.
- Participates on end of shift report with charge nurse.
- Provides end of shift report on cases that need further follow up and or have potential discharge issues.
- Uses clear, concise, professional communication with coworkers, patients, all customers internal and external.
- Uses AIDET in interactions with patients and family members. Utilizes white boards for patient communication.
- Collaborates across disciplines to assist in coordination of patient care, including but not limited to patient transfer, discharge, referrals, and spiritual / psychosocial support needs.
- Acts with a sense of urgency when performing tasks.
- Basic unit / department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
- Reports on any equipment and or environmental issues for repair.
- Abides by HIPAA (Health Insurance Portability and Accountability Act) regulations.
- Utilizes SBAR (Situation, Background, Assessment, Recommendation) when communicating with physicians and health care team
- Speaks up to stop the line and escalates potential safety events if necessary.
- Completes and attends training as assigned.
- Other duties as assigned.
Behavioral Standards :
Communication / Knowledge :
Collaboration / Teamwork :
Qualifications : Experience :
Education :
Licensure / Certifications :
Note : Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
Employee Name : Employee Signature :
Date :
Supervisor Signature :
Date :
Case Manager
ADA / Physical Demands :
Never
Occasion
33% of time
Frequent
44-66% of time
Continue
67-100% of time
Never
Occasion
33% of time
Frequent
44-66% of time
Continue
67-100% of time
Lift / Carry
Equipment Use & Operation
1 to 10 lbs
Motor Vehicles
11 to 20 lbs
Operate Foot Pedals
21 to 50 lbs
51 to 75 lbs
Work With / Near
76 to 100 lbs
Machinery
Electricity
Push / Pull
Power Tools
1 to 10 lbs
Impact Tools
11 to 20 lbs
Chemicals
21 to 50 lbs
Fumes
51 to 75 lbs
Heights
76 to 100 lbs
Environment 1
Movement
Indoors
Bend / Stoop / Twist
Outdoors
Couch / Squat
Extreme Heat
Kneel / Crawl
Extreme Cold
Reach Above Shoulders
Dusty
Reach Below Shoulders
Excessive Noise
Repetitive Arm Use
Other (explain)
Repetitive Wrist Use
Other : N / A
Repetitive Hand Use
a) Grasping
Endurance
b) Squeezing
Task
Hours at One Time
Hours in an 8 hr day
Climb Stairs / Ladder
Variable
Uneven Walking Surface
Stand
Variable
Even Walking Surface
Walk
Variable
Additional Considerations (including clarification of any of the above) 1
Vision Requirements 1
Lifts should always be done following proper approved lifting procedures
Depth Perception
Less than 20 Inches
Color Vision
Peripheral Vision
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. Additional duties and responsibilities may be required of the job holder based upon business needs and at the request of Pipeline Health Management.
