What are the responsibilities and job description for the Case Manager - RN (Hospital Rounding) position at PATHWAYS HEALTH PARTNERS,?
Pathways Health Partners
Pathways Health Partners is an Accountable Care Organization (ACO) on the forefront of helping independent providers make the transition to Value-Based Care. Pathways operates a Medicare REACH ACO, a Medicare Advantage MSO, and a Commercial MSO responsible for approximately 16,000 patients throughout North-West/Central Florida. Our service area is The Villages, down to St. Petersburg, across to Mount Dora, and areas in between. Pathways also operates a robust hospital medicine group, manages several of its affiliated medical practices, and an insurance agency.
Job Summary
Primary duties of the Case Manager – Nurse (RN) will include rounding patients in the hospital, communicating with patients at bedside and other treating providers for care coordination, management of prescriptions and resources for patients. The Case Manager – Nurse (RN) will conduct, and document assessments of patient needs and resources for effective self-care management.
Role and Responsibilities
Position Responsibilities:
Specific:
- Provides case management services for both inpatient and observation patients as assigned.
- Identifies patients at risk for adverse outcomes during the transition from one level of care/setting to another.
- Performs a comprehensive assessment of psychosocial, medical and discharge needs of patients/family along with an assessment of resources appropriate and available to the patient/family.
- Reassess the patient’s clinical condition as indicated.
- Considers patient’s readmission status or risk of readmission and develops strategies to mitigate including education on appropriately accessing healthcare resources, preventative education, and community-based resources.
- Coordinates the care plan and drives the discharge plan by collaborating with the multidisciplinary health care team and the patient's physician to facilitate a successful care transition.
- In partnership with Social Services, the RN CM is responsible for ensuring the post-acute medical needs and level of care are appropriate.
- Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established chain of command.
- Makes appropriate referrals to third party payer, disease and case management programs for recurring patients and patients with chronic disease states.
- Facilitates patient throughput with an ongoing focus on an effective care transition, quality, and efficiency.
- Documents professional recommendations, discharge plan, care coordination interventions, and case management activities to effectively communicate to all members of the health care team.
- Adheres to established policy and procedure and standards of care; escalates issues through the established chain of command timely.
- Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives Serve as an advocate for patient's rights, needs, and values; ensuring that patients’ ethnic, cultural, or religious values, beliefs, preferences, and needs are considered and aligned.
Core:
- Works well independently and has strong operational skills
- Excels at customer service and has strong interpersonal skills
- Strong organizational and time management skills
- Demonstrates a positive attitude and maintains a positive corporate culture
- Communicates effectively and has strong verbal, non-verbal, and written communication skills
- Develops strong relationships with coworkers and other stakeholders
- Learns quickly and has strong problem-solving and critical-thinking skills
- Willingness to continually self-educate and grow professionally
- Prompt and regular attendance
- Assist and perform additional duties as asked or assigned
Qualifications and Education Requirements
- Education: Successful completion of a Registered Nurse program from an accredited college, BSN preferred
- Experience: Minimum 1 year practicing nurse either as a MA, LPN, or RN
- Certification/Licensure: Active and Clear RN License in Florida. CPR/AED or BLS PALS certified at time of hire.
- Training and Knowledge Required at Time of Hire: Registered Nurse program curriculum completion,
- Age Specific Individuals Served/Responsibility: Adults
- Security Measures and Clearance: Up to a Level 2 clearance
- Two years’ demonstrated experience in a medical or health plan environment
- Excellent computer skills with experience in Outlook, MS Office, MS Excel, MS Word
- Strong presentation skills, positive and effective communication skills
- Strong typing skills
Why Work for Pathways?
Pathways Health Partners is a growing company based in Leesburg, FL. We are proud of our professional yet family culture with the executive team working daily alongside our team members. We provide competitive salaries, bonuses for all team members, and a benefits package that is second to none.
- Medical Insurance for Employee and Spouse/Significant Other paid up to100% by Pathways!
- Addition of family coverage for dependents at a fraction of the cost
- 25K life insurance for employees 100% paid by Pathways!
- Increasing Employee coverage or adding spouse/dependents at a fraction of the cost
- Vision and Dental Coverage available at a very low cost for employees, spouses, and family
- 401K retirement plan with 100% match up to 4% of annual pay
- Paid holidays
- Ample Paid Time Off (PTO) for vacation/sick/personal days
We look forward to speaking with you about this opportunity!
