Case Manager - RN - Continuum of Care (Per Diem)

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POSITION SPECIFICS

Title: Case Manager - RN

FTE: Per Diem

Schedule: Variable, as needed coverage.

Holiday Rotation: N/A

Weekend Rotation: N/A

On Call Requirements: N/A

POSITION SUMMARY

The Case Manager- RN coordinates and facilitates patient care activities to promote optimum and appropriate utilization of resources, improve continuity of care across the continuum, and to contribute to patient satisfaction and outcomes. T he Case Manager- RN evaluates patient health status, facilitates the proper plan for care and manages the implementation of nursing services to meet the patient’s individual health needs. This position acts as a patient advocate, a resource to patients, families and staff, and as a leader of the interdisciplinary team. This position s erves as a liaison between the patient and family, and the care provider.

This individual may provide more specialized support in areas such as the utilization management (UM), Swing Bed, post-acute care navigation, transitional care management and other areas that help improve the continuity of care of a patient across the continuum.

POSITION TECHNICAL RESPONSIBILITIES

• Assist and supports development of Population Health care model at SPH. Actively partner with skilled nursing facilities, home health, primary care clinics, Social Workers/RN Case Managers and Population Health team to proactively identify and resolve potential barriers and constraints.
• Use assessment skills and appropriate risk assessment tools to identify patients with actual or potential health care needs that would require care coordination .
• Collaborate with patient/family in establishing mutual goals based on the patient's needs or problems.
• Explore patient's understanding and knowledge of current health status. Partners with patient to help them integrate health status changes into their life.
• Apply nursing judgment to determine level of care assigned or delegated. Monitor, detect and anticipate early and subtle health status changes.
• Monitor, trend and record patient response to disease, illness, treatment.
• Coordinate care across the continuum (inpatient/outpatient/community) to assure appropriate utilization of clinical and community resources. Promptly intervenes in instances of delayed services or inappropriate utilization of resources.
• Coordinate input from all health professionals, conduct assessments of patient/family needs and formulate a documented plan assuring continuity of care for the highest risk patients or those patients at risk for poor outcomes.
• Conduct precertification, concurrent, and retrospective utilization management through the application of nationally recognized criteria.
• Collaborates with Social Work and other members of the care team to integrate psychosocial management of patient/family needs.
• Coordinate and lead family conferences and/or multidisciplinary care conferences as needed.
• Document accurate assessments and interventions in patient’s electronic medical record in an effective and timely manner
• Assess patient’s unique perspective and assure right education, right time, right environment for learning. Anticipate future needs and educates or refers to valid sources of information.
• Delegate care based on situation while assuming accountability for patient outcome. Assure effective use of staffing resources. Support assistive personnel. Serve as a resource and hold assistive personnel accountable to complete delegated tasks.
• Continually evaluate program data to further refine the referral criteria to case management; provides feedback to staff to improve the referral process.
• Identify actual or potential variances in standards of care and system problems that could lead to errors, delays in care, complications or increased cost. Contact providers, staff and/or applicable leadership personnel to resolve these findings.
• When appropriate, integrate care coordination with disease management efforts to achieve low-cost interventions that achieve the greatest benefit and increase the accountability of patients for management of their disease.
• Analyze data to identify under/over utilization; improve resource consumption; promote potential reduction in cost; and enhance quality of care consistent with organization strategic goals and objectives. Data includes but is not limited to predictive analysis, risk stratification, cost-benefit analyses, financial analyses, clinical outcomes, utilization, and practice patterns.

POSITION REQUIREMENTS

Education:

• Required: Associate Degree in Nursing
• Preferred: Bachelor’s degree in nursing (BSN) or Master’s Degree in nursing (MSN)

Experience:

• Required: Minimum of 2 years of nursing, case management or utilization review experience
• Preferred: Two or more years of experience of case management and/or Utilization Review in a healthcare setting

Licenses and Registrations:

• Required: Current State of Wisconsin licensure as a Registered Nurse
• Preferred: None

Certification(s):

• Required: Basic Life Support (BLS) – within 3 months of hire
• Preferred: Case Management certification

BENEFIT SUMMARY

• Retirement plan with immediate vesting and employer match
• Discounted membership to our state-of-the-art fitness facility
• Free parking at facility

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