Registered Nurse Case Manager
Company: KentuckyOne Health
Posted on: March 19, 2019
Position Type: RegularScheduled Hours per 2 week Pay Period: 80Primary Location: KY > LEXINGTON > SAINT JOSEPH EASTJobSummaryWorks collaboratively with physicians,staff and other healthcare professionals within his/her Division to coordinate the care andservice of selected patient populationsacross the continuum within the acute care setting.The role works collaboratively with patient, family, physicianandother members of the health care team to achievethe highest quality clinical outcomes with the most costeffective use of available resources. The Case Manager assumes responsibility foraninterdisciplinary process which assesses, plans,implements, monitors and measures the effectiveness ofinterventions to meet patients' treatment and transitional needs.The Case Manager isknowledgeable about various age-related care protocols and functions within their scopeof practice. The Case Manager an integral member of the healthcare team as well as the Divisional Care Management department.-- Collaborateswith the Divisional Care Management team on system-wide quality improvement/performanceimprovement initiatives.--EssentialFunctionsIdentifies priority patients requiring care management services.Collaborates with the patient, family, physician and otherhealth care professionals to perform initial and concurrent patient assessment and referrals/ recommendations.Develops individualized care management care plans in collaborationwith patientand family to facilitated care and decrease variances.Uses severity of illness/intensity of servicesindexes to determine appropriatenessof admissions,level of care, transfersand continued stays.Advocates for adherenceto best practice standards throughuse of approved guidelines, protocolsand order sheets.Works in conjunction with Utilization Management teamin communicating and negotiating with commercial payers orother outside agenciesin order to obtain needed services for patients and accuratereimbursement for thehospital.Identifies opportunities to reduce risks, both financial and clinical.Provides Important Message from Medicare letters topatients prior to discharge.Prepares and provides HINN lettersper policy.--Transitional/Discharge PlanningWorks with interdisciplinary teamto coordinate needed servicesto ensure efficient continuity of care.Assesses need for services throughmultidisciplinary rounds onpatients and collaboration with physicians and other interdisciplinary team members.Plans for careneeds with active involvementof patient, family, and hospital staff involved in treatment process.Oversees implementation of transition plans withsupport from internal and externalagents.Monitors patients'progress and adequacy ofplanning process through regularcommunication with patients and service providers.Documents actions in medical record accordingto departmental guidelines and overseesprocess of exchangeof information with other facilities/agenciesadhering to legal mandates aboutconfidentiality.Monitors and measureseffectiveness of care plan interventionsthrough direct communication with patients and caregivers and review withdepartment leadership of definedindicators (e.g., overalllength of stay, readmission rates,feedback from referralsources, etc.).Identifies barriers or gaps in community resources that impact outcomes and discharge.Ensure effective hand-offs fordischarge home or sub-acute care.Provides backup support for Utilization Management.--Accountability for results:Understands and self-managesto support facility success goals, including improvementsin quality, cost of care and member experience for the facility/CIN's population.Identifies opportunities for improvement (at individual and facility levels) and actively workswith healthcare and facility team to correct or improve results.--Skills,Knowledge or Abilities:critical to this role: Demonstrated experience in case management, discharge planning, and transfer coordination.Experience with MCG/Indicia (formallyMilliman Care Guidelines) authorization criteria preferred.Knowledge of Cerner electronic health record preferred. Must have excellent computer skills andability to learn new systems.Must have strong organizational (timemanagement) skills, stronginterpersonal skills, the ability to handle multiple priorities with strong attentionto detail.Knowledge of andpractical use of goodbusiness English, spelling,arithmetic, practicesand the ability to communicate effectively using writtenand verbal skills. Proficientin emailcommunications and internet usage alongwith basic use of Microsoft Excel and Word.Knowledge of information technology to evaluatecare effectiveness (care process, outcomesand cost).Ability to workautonomously within matrix environment without direct supervisionor support.-- JobRequirements / QualificationsEducation / Accreditation / Licensure(required & preferred):Current unrestricted license, as aregistered nurse, in state(s) of practice is required.Bachelor of Science in Nursingrequired; Masters of Sciencein Nursing preferred. Will accept equivalentexperience in lieu of degreeif the candidate obtains his/her BSN within3 years post hire. Case Management certification (CCM or ACM) preferred.--Experience(required and preferred): Minimum 3 yearsclinical experience as Registered Nurse (RN) required.Minimum 1 yearcare management experience preferred. Additional Information Requisition ID: 2019-R0211481 Schedule: Full-time Shift: Day Job Market: CHI Saint Joseph Health
Keywords: KentuckyOne Health, Lexington , Registered Nurse Case Manager, Executive , Lexington, Kentucky
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