Case Management Team RN

Job Summary

Reviews all admissions to the hospital and reviews continued stay. Classifies all patients according to mandated federal and state regulations. Works with all departments to ensure quality continued stay and discharge planning. Facilitates the development of an interdisciplinary plan of care in conjunction with patients and families. Accurate timely documentation in medical record including clear communication with clinical discharge planner, nurse and QMP Functions as a liaison between hospital, physician, patient and payer to obtain maximum reimbursement for patient care services. Assists in the maintenance of communication between providers involved in patient care. Maintains compliance responsibilities. Screening patients to identify those at higher risk of needing more extensive Case Management based on objective criteria. Advocacy for patients and families, facilitates referrals to state and local financial assistance programs. Coordination of patient care conferences as needed for complex discharge planning issues. Serves as an advocate for the patient and coordinates with the acute care team members, payers and community resources to leverage resources to meet patient's clinical and discharge needs. Collaborates with providers and nursing staff to identify patients appropriate for discharge today / tomorrow. Collaborates with UM Nurse to expedite discharges when payer denies admission or continues stay. Leads Multi-disciplinary Rounds : facilitates identification of barriers to clinical progression discharge and assigns accountability for follow-up actions identified during rounds. Identifies and documents avoidable days. Identifies and addresses quality of care, safety, under / over utilization of resources and discharge planning barriers. Refers cases to physician advisor and second level review. :

• Patient does not meet criteria for ordered level of care, Identified quality of care concerns, Identified delays in care, and over / Under utilization of resource. Provides direction and appropriately delegates tasks to the Clinical Discharge Planner, Unit Nurse or QMP to arrange for post-acute services : Home health care, durable medical equipment etc. and ensure plan is complete. Maintains current knowledge of health care economics, trends and reimbursement methodologies, and applies this knowledge to daily practice. Duties to be assigned at hire by Manager / Director.

Job Requirement

Minimum Education Requirement :

Graduate of a school of nursing.

Minimum Experience Requirement :

Minimum 3-5 years of clinical nursing experience, preferably in acute care settings. Prior experience in case management, discharge planning or utilization review strongly preferred. Familiarity with federal and state regulations regarding patient care and hospital operations. Strong critical thinking, problem-solving, and decision-making abilities. Proficient in electronic medical records (EMR) systems and documentation standards, Knowledge of insurance and reimbursement processes, including Medicare and Medicaid. Ability to work collaboratively in a fast-paced and interdisciplinary environment. Critical care experience is strongly recommended. Must possess and demonstrate knowledge of the growth and development of varied age groups, neonatal to geriatric. Ability to correlate statistical information and outline necessary steps involved in problem solving. Aptitude for repetitive activities. Organizational ability. Demonstrated ability to handle confidential hospital information. Well developed critical thinking skills. Knowledge and understanding of medical terminology. Ability to communicate effectively with medical professionals of all disciplines. Clear verbal and written communication skills, excellent phone etiquette. Knowledge of QI process and facility wide process improvement projects including but not limited to overall patient safety. Ability to identify potential and actual patient occurrences that may be reportable incidents or those requiring further internal investigation.

Minimum License Requirement :

Active and unencumbered Registered Nurse (RN) license in NY State. Certification in Case Management (e.g. CCM ACM) preferred. Samaritan is an Affirmative Action / Equal Opportunity Employer. Women, Minorities, Disabled, and Veterans are encouraged to apply.