Care Management RN

Miami Children's Miami , FL 33196

Posted 2 months ago

Job Summary

Oversees the transition of the patient through the healthcare spectrum from admission to discharge ensuring optimal level of wellness. Enhances care coordination through planning, assessing, re-assessing, implementing, monitoring, and evaluating care options and services to meet the individual plan of care needs for the pediatric patient through Utilization Resource Management, Transition of Care, Discharge Planning, and Care Management.

#INDHP

#CA-LB

Minimum Job Requirements

  • BSN degree or currently enrolled in BSN program.
  • RN Licensure within the State of Florida or Multi-State Enhanced Nursing License Compact (eNLC) - maintain active and in good standing throughout employment
  • 1-3 years of pediatric or adult acute clinical hospital experience.
  • 1-3 years experience in Case Management, designated/pediatric specialty, program/project development, Utilization Management, and/or Clinical Pathways.

Knowledge, Skills, and Abilities

  • National Certification in Case Management through an accredited body preferred.

  • Experience in discharge planning, clinical pathways, and continuous quality improvement highly desirable.

  • Leadership experience is highly preferred.

  • Basic proficiency in Microsoft Word, Excel, and Outlook.

  • Able and available to work a flexible/rotating schedule including holidays and weekends.

  • Able to communicate effectively both verbally and in writing in a clear, concise, and courteous manner.

  • Fluent in Spanish preferred.

  • Working experience with various technologies, hospital information systems, and other tools used in patient financial services, particularly Cerner.

  • Able to interpret, adapt, and react calmly under stressful conditions in a pleasant manner.

  • Able to relate cooperatively and constructively with customers and co-workers.

  • Able to maintain confidentiality of sensitive information.

  • Able to establish necessary professional relationships, and interact effectively with internal and external customers.

  • Able to work in a fast paced environment, and effectively manages and uses resources to successfully meet the competing deadlines of a variety of tasks, problems, and projects.

  • Able to use logical and analytical thinking to interpret technical data, and solve a broad range of problems.

  • Able to work independently when interacting with organization's clinical and non-clinical customers and outside vendors/payors.

Job Specific Duties

  • Transitions care to external providers, community partners, and services to achieve quality outcomes for the patient and family.

  • Facilitates efficient care transitions for the pediatric patient through defining discharge and transition of care criteria through an individualized patient centered plan of care.

  • Conducts initial assessment of the patient and family within 24 hours to identify potential transition of care and discharge barriers and needs.

  • Develops a relationship with patients and families to partner for safe transition of care through the healthcare spectrum.

  • Collaborates with the inter-professional team to implement safe and timely transition and discharge planning. Proactively identifies, and resolves delays and obstacles for safe discharge.

  • Coordinates and facilitates inter-professional team meetings, advocating on behalf of the patient, focusing on the transition needs of the patient.

  • Drives and actively participates in case management and unit specific conferences with Medical Director to facilitate transition of care through discussion and identification of complex cases.

  • Develops and implements a patient centered specific plan of care and makes referrals based on the needs assessment & available resources in conjunction with members of the inter-professional team.

  • Coordinates medical discharge planning needs specific to pediatric patients including medication authorization, DME, supplies, home health nursing & inpatient/outpatient rehab, etc.

  • Screens charts to determine admission and concurrent level of care criteria; monitors daily plan of care.

  • Collaborates to eliminate barriers of efficient delivery of care in appropriate setting, LOS, and readmission prevention.

  • Coordinates with health care team to assess & identify issues/needs that may impact on transition of level of care & discharge. Applies cost benefit analysis when planning for discharge needs.

  • Collaborates with family, health care team, payers, providers, & community partners to achieve appropriate resource management to implement safe transition and discharge plan established.

  • Assists in identifying variances in utilization of resources & avoidable days/denials. Collaborates with Utilization Management RN, Appeals Management, & Medical Director in the appeals process.

  • Responsible for the appropriate use of software and applications when available and enters case management information accurately and in a timely manner.

  • Participates in departmental initiatives/opportunities for improvement through departmental and unit council assignments, including interdisciplinary rounds and LEAN projects.

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Care Management RN

Miami Children's