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RN-CASE MANAGER

Company: CHI Saint Joseph Health
Location: Lexington
Posted on: July 14, 2019

Job Description:

Position Type: RegularScheduled Hours per 2 week Pay Period: 80Primary Location: KY > LEXINGTON > SAINT JOSEPH HOSPITAL Job Summary / Job Purpose -- Works collaboratively with physicians, staff and other health care professionals within his/her Division to coordinate the care and service of selected patient populations across the continuum within the acute care setting. The role works collaboratively with patient, family, physician and other members of the health care team to achieve the highest quality clinical outcomes with the most cost effective use of available resources. The Case Manager assumes responsibility for an interdisciplinary process which assesses, plans, implements, monitors and measures the effectiveness of interventions to meet patients' treatment and transitional needs. The Case Manager is knowledgeable about various age-related care protocols and functions within their scope of practice. The Case Manager an integral member of the health care team as well as the Divisional Care Management department.-- Collaborates with the Divisional Care Management team on system-wide quality improvement/performance improvement initiatives. -- -- Essential Functions -- Identifies priority patients requiring care management services.Collaborates with the patient, family, physician and other health care professionals to perform initial and concurrent patient assessment and referrals / recommendations.Develops individualized care management care plans in collaboration with patient and family to facilitated care and decrease variances.Uses severity of illness/intensity of services indexes to determine appropriateness of admissions, level of care, transfers and continued stays.Advocates for adherence to best practice standards through use of approved guidelines, protocols and order sheets.Works in conjunction with Utilization Management team in communicating and negotiating with commercial payers or other outside agencies in order to obtain needed services for patients and accurate reimbursement for the hospital.Identifies opportunities to reduce risks, both financial and clinical.Provides Important Message from Medicare letters to patients prior to discharge.Prepares and provides HINN letters per policy. -- -- Transitional/Discharge Planning Works with interdisciplinary team to coordinate needed services to ensure efficient continuity of care.Assesses need for services through multidisciplinary rounds on patients and collaboration with physicians and other interdisciplinary team members.Plans for care needs with active involvement of patient, family, and hospital staff involved in treatment process.Oversees implementation of transition plans with support from internal and external agents.Monitors patients' progress and adequacy of planning process through regular communication with patients and service providers.Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/agencies adhering to legal mandates about confidentiality.Monitors and measures effectiveness of care plan interventions through direct communication with patients and caregivers and review with department leadership of defined indicators (e.g., overall length of stay, readmission rates, feedback from referral sources, etc.).Identifies barriers or gaps in community resources that impact outcomes and discharge.Ensure effective hand-offs for discharge home or sub-acute care.Provides backup support for Utilization Management. -- Accountability for results: Understands and self-manages to support facility success goals, including improvements in quality, cost of care and member experience for the facility/CIN's population.Identifies opportunities for improvement (at individual and facility levels) and actively works with healthcare and facility team to correct or improve results. -- Job Requirements / Qualifications -- Education / Accreditation / Licensure (required & preferred): -- Current unrestricted license, as a registered nurse, in state(s) of practice is required.Bachelor of Science in Nursing required; Masters of Science in Nursing preferred. Will accept equivalent experience in lieu of degree if the candidate obtains his/her BSN within 3 years post hire. Case Management certification (CCM or ACM) preferred. -- -- Experience (required and preferred): -- Minimum 3 years clinical experience as Registered Nurse (RN) required.Minimum 1 year care management experience preferred. -- -- -- -- -- -- -- Additional Information Requisition ID: 2019-R0228527 Schedule: Full-time Shift: Day Job Market: CHI Saint Joseph Health

Keywords: CHI Saint Joseph Health, Lexington , RN-CASE MANAGER, Executive , Lexington, Kentucky

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