CASE MANAGER RN - Weekends

FLSA Status

Exempt

#EXPRN

Job Role Summary

The weekend Case Manager and Discharge Coordinator serves as the overall coordinator of care, collaborating in tandem with Social Work counterpart, Physicians, Interdisciplinary Team, Nursing, and patients/families to provide seamless and efficient service for the trauma and orthopedic teams. This position is responsible for managing each patient's plan of care, monitoring for appropriate resource utilization, and coordinating the patient's discharge plan.  The schedule for this position will be three weekends per month with one weekend off.  The incumbent will work 40 hrs. per week with their hours focused on weekends and making up the remaining hours during the week to reach 40 total.  The one week per month when the weekend is not worked, all 40 hrs. will be obtained during the standard work week.

Essential Functions and Responsibilities

• Overall coordinator of care, collaborating with Social Work counterpart, Physicians, Interdisciplinary Team, Nursing, and patients/families to provide efficient services for the trauma and orthopedic teams
• Manages each patient's plan of care, monitoring for appropriate resource utilization, and coordinating the patient's discharge plan
• Coordinates the patient's care,serving as a patient advocate, delivering efficient health care
• Communicates with Physicians, Physician extenders (Nurse Practitioners, Physician Assistants), Interdisciplinary Team, Nursing, and patients/families to ensure timely patient progression through the episode/plan of care
• Resolves problems impeding diagnostic or treatment progress and proactively resolves delays to discharge
• Utilizes conflict resolution, critical thinking, and negotiation skills to ensure timely resolution of issues
• Identify strategies to reduce the length of stay and resource consumption within the targeted population
• Personally interview patients and other relevant sources to collect information in an attempt to identify individual needs and develop a comprehensive plan of care that addresses medical, social, and financial needs
• Collaborate with the teams, Transition Support leadership and Medical Director to identify cases that require special intervention
• Documents avoidable days and quality indicators as appropriate
• Actively participates in creating/planning an action-oriented and time specific plan of care
• Assures adherence to clinical pathways/protocols and the appropriate use of clinical tools through collaboration with Physicians, Interdisciplinary Team, Nursing, and unit staff
• Continually monitor patients for change in condition warranting initiation of a clinical pathway, alteration in plan of care, or change in care acuity in an attempt to determine the effectiveness of the care plan
• Evaluates at appropriate intervals that the quality of healthcare to each patient is delivered in an efficient manner throughout the patient's episode of care
• Educate rotating surgical residents on case management duties and new updates to maintain compliance
• May conduct or provide oversight of the initial admission review, utilizing InterQual criteria, within 24 - 72 hours of the patient's admission to the hospital to ensure appropriateness of the assigned level of care and timely implementation of the treatment plan.
• Applies InterQual criteria to complete concurrent reviews as indicated by payer or ~ every 72 hours.
• Educates Physicians, Interdisciplinary Team, and Nursing regarding payer sources and the role this plays in discharge planning
• Communicates as necessary with the on-site private payer/managed care Case Managers
• Coordinates with Social Work regarding Financial Counseling and or Case Enhancement Specialist to assure private payer pre-certification/authorization for services is obtained when required
• Addresses private payer denials
• Evaluates the active funding for each patient and communicates with Financial Counseling to facilitate the initiation of appropriate funding applications
• Addresses financial barriers to healthcare/medical compliance with the patients/families when indicated
• Coordinates discharge planning for assigned patient with Social Work
• Facilitates discharges to post-acute services such as LTACs, Skilled Nursing Facilities, or Nursing Homes and discharge planning including Home Health Care and durable medical equipment
• Documents relevant Case Management Process and discharge planning information in medical record

Job Requirements

• Active RN license in the State of Indiana, or ability to obtain licensure through application
• Minimum of 5 years of clinical nursing experience

Knowledge, Skills & Abilities

• Demonstration of Case Management knowledge and managed care processes
• Competency in: