RN-Hospice Case Manager

Description

Operational Definition:

The RN Case Manager will provide the following functions in their daily role: utilization review, discharge planning, and care coordination for all levels of patient care in the facility.

SPECIFIC RESPONSIBILITIES

1. Admission reviews for both federal and non-federal patients utilizing approved criteria.
2. Conducting continued stay reviews for both federal and non-federal patients utilizing approved criteria.
3. Application of Condition Code 44 per CMS guidelines.  
4. Demonstrates knowledge of various levels of care offered in the facility. These include the following: Acute/Inpatient, Observation, Outpatient Surgery Observation, Swing Bed, Critical Care and IVT.
5. Demonstrates effective critical thinking skills and problem solving with difficult patient situations to foster positive outcomes.
6. Maintains all required documentation and retention of records as outlined in facility policies.
7. Identification of potential abuse and neglect and compliance with reporting standards.
8. Demonstrates knowledge of regulatory standards that apply to the area of practice in Case Management.
9. Effective communication with staff, physicians, patients, families and visitors and all community agencies.
10. Performs admission assessments on patients of Ohio County Healthcare and initiates discharge planning at the point of assessment. Risk assessment performed for potential environmental hazards to patient.
11. Assessment of all Private Pay patients and assistance with resource navigation.
12. Understands and maintains compliance with the MOON notice per CMS guidelines.
13. Understands and maintains compliance with the Important Message from Medicare per CMS guidelines.
14. Understanding of Medical necessity precertification process for outpatient infusion and injection patients.
15. Maintains strong working relationships with Community Health, Welfare and Social agencies.
16. Participates in opportunities for continuing education and professional self-development.
17. Maintains a current license in the state of Kentucky.
18. Assures proper and timely documentation in patient medical records.
19. Serves as a liaison between Ohio County Healthcare and community agencies on behalf of the patient to provide continuity of care after facility discharge.
20. Maintains confidentiality in all patient records and interactions.
21. Responds promptly to all referrals.
22. Attends regularly scheduled meetings.
23. Observes personal hygiene and dress code as outlined in the Ohio County Healthcare personnel policies.
24. Is accountable for ensuring patient safety during the course of performing all duties.
25. Schedules and notifies all disciplines, patients and their families of Swing Bed Care Conferences.
26. Facilitates and documents all Swing Bed Care Conferences.
27. Participates in New Employee Orientation to educate on abuse and neglect.
28. Actions are consistent with Ohio County Healthcare’s purpose, vision, and values.
29. Adheres to Ohio County Healthcare’s legal and compliance program.
30. Early identification and notification of KODA if applicable.
31. Understanding of role in emergency situations in the facility.
32. Demonstrates an understanding of Policy Tech and OCH Common Drive.
33. Demonstrates an understanding of Nex-Talk Interpreting Services.
34. May be requested to be member of QI team.
35. Frequently accesses email to stay up to date on information within the organization and provides a way of communication between staff members.
36. Involvement in the emergency department to help facilitate appropriate admission, discharges and transfers.
37. Assistance with reporting data as applicable as specific roles and responsibilities.

Qualifications

Associate of Science of Nursing Degree (RN), Bachelor of Science in Nursing preferred (BSN). BLS Provider or equivalent knowledge or obtains within six months of employment; ACLS provider and PALS provider strongly encouraged.