CASE MANAGER RN

JOB SUMMARY:

Primary responsibility for case management and 3 rd party utilization review activities of assigned case load. Facilitates patients’ movement through the continuum of care in a timely, efficient, and cost effective manner, while ensuring the maximum attainable goals for the patient are achieved. Focuses on appropriate utilization of resources, proactive discharge planning, continuity and quality of care through an interdisciplinary team, including the patient/family/significant others

ESSENTIAL FUNCTIONS:

1. Coordinate the initial case management assessment and development of individualized case management plans for patient to ensure quality of care and achievement of optimal clinical outcomes. Communicates and collaborates with patient, family/significant other, and all other members of care team.
2. Monitors and evaluates utilization of individualized case management plans. Identifies potential problems and potential barriers to discharge. Reviews records for medical necessity, ensures appropriate level of care, and conducts third party certification review as needed. Makes timely referrals to social services and identifies issues that need to be reported to the Department of Protection and Permanency.
3. Anticipates and develops appropriate discharge plan that enable patients to progress to the most independent, post hospital care setting in a timely manner. Consults with social services, physicians, patient and family members about discharge planning and alternative treatments plans.
4. Identifies, tracks, and addresses clinical or system variances that delay progress through the course of hospital care. Tracks/reports statistical information to promote quality of care. Resolves or refers avoidable delays to appropriate personnel and/or department for follow-up.
5. Provides specific recommendations to care team members to ensure, appropriate cost effective alternatives. Relays information to members of the denials management team, review organizations, insurance companies, and physicians to obtain certification and reverse denials.
6. Acts as a clerical and education resource on case management, clinical pathways, and resource utilization.
7. Provides orientation and training for new employees.
8. Adheres to dress code.
9. Meets all departmental specific competencies.
10. Adheres to medical center policies addressing infection control, safety, and personnel guidelines.
11. Demonstrates knowledge of and compliance with the medical center code of conduct and applicable corporate policies and procedures.
12. Maintains patient confidentiality and treats patients and families with respect and dignity.
13. Performs all other duties as may be assigned.

ADDITIONAL RESPONSIBILITIES:

Will serve as a clinical resource for the learners at the AVA Center and includes basic pediatric first aid and emergent management of anaphylaxis and administration of anti-seizure medications.

JOB REQUIREMENTS:

Experience with general office equipment. Basic Pc skills required. Experience with Windows XP and Microsoft Office suite software required.

Basic computer skills including:

1. Turn on our personal computer on and off.

2.Recognize the four major parts of the computer

1. Identify and explain the use of the four parts of the standard keyboard.
2. Recognize the mouse and understand how to use it.
3. Open and close a program using Windows XP
4. recognize and understand the operator panel of a printer
5. Recognized and understand the operator panel of a fax
6. Load paper

EDUCATION AND LICENSURE:

High school diploma or equivalency required. Associates Degree in Nursing is required. Current KY RN licensure is required. BLS training is required.

WORKING CONDITIONS:

Works in a well lighted business office environment the majority of the time.

There is a potential for being at risk of exposure to hazardous chemicals when working. Information regarding hazards and protective measures along with training on handling and storage of hazardous materials will be provided prior to initial assignment to work with hazardous chemicals, whenever the hazard changes , and on an annual basis.

FOR DIRECT PATIENT CARE JOBS, AGES OF PATIENT SERVED:

Not a Direct Patient Care Job _______

______All age groups (Birth and Above)

___X_ Neonate (Birth to 1 month)

___X_ Infant (1 month to 1 year)

___X_ Early Childhood (1 year to 5 years)

___X _Late Childhood (6 years to 12 years)

___X_ Adolescence (13 years to 17 years)

______Young Adult (18 years to 25 years)

______ Adult (26 years to 54 years)

______ Senior Adult (55 years to 64 years)

______ Geriatric (65 years and above)

EDUCATION AND LICENSURE:

1. Registered Nurse currently licensed in Kentucky.
2. BLS training is required.
3. Minimum 3 year work experience in hospice, general medical surgical, home health, and/or geriatric nursing.
4. Demonstrates commitment to the philosophy of care, values, mission statement and organizational culture of Pikeville Medical Center and the Palliative Care Department.