What are the responsibilities and job description for the Care Manager, 64 hours bi-weekly position at Northwestern Medical Center?
Nurse Care Manager
JOB SUMMARY:
Conduct individualized concurrent clinical evaluations of patients, their health needs, and concerns; review patient medical record for medical necessity, develop personalized action plans, provide education, and issue referrals for post-acute care; monitor patients’ progress in meeting established goals and modify care plans accordingly. Provide clinical information to health insurers as required. Work closely with interdisciplinary care team and technology to identify high-risk, complex patient cases; manage care, provide care planning, referral management, post-discharge planning, and coordinating community-based and transitional care. Develop a cohesive and strong team-oriented relationship with physicians, nurses, and other healthcare professionals; evaluate and report on patient health outcomes and work in partnership with interdisciplinary healthcare team to facilitate the best in patient care. Direct discharge planning process in support of treatment adherence and medication compliance; assist with transitions for patients discharged from an in-patient hospital to post-discharge care; include patients and caregivers in transition of care planning; Advocate for decreased hospital stay when appropriate. Guide, intervene and advocate on behalf of patients, their caregivers and/or families regarding navigating and comprehending the healthcare system; coordinate resources in the community to ease transition. Maintain accurate and timely records of all patient-related interactions. Work in an intensive, fast-paced environment with minimal supervision
PRE-REQUISITES:
Education: Graduate of an accredited school of licensed practical nursing or registered nursing with current licensure as a Registered Nurse or Licensed Practical Nurse in the State of Vermont. BSN or MSN strongly preferred. Would also consider Master's Degree in Social Work, Counseling, Psychology of LMSW strongly preferred. A Bachelor’s degree in similar field with combination of work experience.
Experience: Three years in a hospital &/or clinic setting preferred. Utilization management and/or case management, community care management experience preferred. Certified Case Manager preferred.
Other Skills:
Certifications:
RELATIONSHIPS:
- Reports To:
o Manager, Case Management
- Supervises:
- Other Contacts:
o Patients, families, hospital staff, community agencies, providers and their staff
SCOPE:
- Machinery or Equipment Used:
o Computer, basic office equipment
- Physical Demands:
o Moderate physical activity, requires manual dexterity, visual acuity and mobility.
- Working Conditions:
o May be exposed to infectious diseases.? contact with patients under a wide variety of circumstances and crisis situations.
- Required Protective Equipment:
o PPE as patient situation or condition dictates according to policy.
ESSENTIAL FUNCTIONS:
Collaborates with internal staff and outside agencies to meet the needs of the patient and their families.
- Collaborates with DCF/APS for issues regarding children and vulnerable adults and files appropriate reports as required by law
- Assists patients of all ages to provide information on resources/services available
- Utilizes community service providers to maximize the patient's ability to function in the community
- Makes appropriate referrals to social service agencies related to financial concerns for adult patients
Supports patients and families during times of transition.
- Coordinates support for post partum mothers and their infants
- Provides information to patients and families regarding end of life care and options
- Supports the emotional needs of patient/family when discussing and/or planning placement in a skilled nursing facility or other long-term care solution respecting feelings regarding their loss of independence
- Supports emotional and clinical needs of chronic disease management, as well as diagnosis
Participates in discharge planning and Care Coordination.
- Assists patients with identifying support systems and services post discharge
- Coordinates with & contributes to inpatient discharge planning activities to ensure patients’ needs are being met, roadblocks/barriers to discharge are addressed, appropriate services/supports are offered
- Communicates with long-term care facilities and home health agencies to facilitate transition back to community setting
Provides information to patient and family that is age specific and appropriate for their level of understanding.
- Acts as a liaison between provider and patient/family to answer questions, clarify issues, and gather information
- Provides information to patients/family to improve their understanding of medical recommendations
Conducts patient record review to determine appropriateness of admission based on established criteria.
- Communicates with providers to ensure appropriate level of care, efficient use of resources, payor requirements, and plans for discharge.
- Collects data related to LOS, denied days, resource consumption and patterns and explores strategies to manage utilization and decrease variation.
- Updates insurance providers as needed regarding plan of care.
