Northwestern Medicine Palos Heights , IL 60463
Posted 3 weeks ago
Description
The Case Manager Flex reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines, and all other regulatory and accreditation standards.
Responsibilities:
Through active involvement in the patient's care, the Nurse Case Manager expedites the patient's progression along the continuum of care to effect timely and appropriate care coordination.
Assists hospital in meeting budgeted LOS by managing ADOD for assigned patients.
Participates in LOS rounds by providing knowledgeable clinical specifics for patient information including discharge plan and barriers.
Works closely with the multidisciplinary team to ensure patient flow through capacity management techniques.
Trends care delivery related issues and provides information to the health Team.
Communicates all regulato1y concerns to the Healthcare Team.
Collaborates with the patient, family, designated caregivers, and multidisciplinary team to facilitate prioritization of care along the continuum.
Collaborates with staff, physicians, and other clinical providers to manage and direct care to reduce variances from expected outcomes.
Intervenes to correct variances to include avoidable days.
Meets directly with the patient/family and develops as individualized plan of care in collaboration with the multidisciplinary team. Re-evaluates and revises the plan of care as necessary.
Communicates and at times rounds with the physician to establish and support the plan of care, address issues regarding acute care stay and manage resource utilization.
Assists physicians, care providers, patients and family in understanding payer plans and benefits as required.
Proactively initiates and facilitates consultations from appropriate disciplines/departments as required to expedite care, monitor length of stay and facilitate a timely safe discharge.
Collaborates with Utilization Review regarding insurance concerns and verification of acute and post-acute benefits, manage concurrent denials, and manage patient status changes including observation and code 44.
Monitors readmission issues and escalates to the Healthcare Team.
Assures compliance with governmental regulations including Medicare three-day inpatient stay for skilled nursing facility, Important Message from Medicare, observation status and code 44.
Participate in the assurance of core measure compliance and best practice principles in the care management of patients.
Assesses and monitors customer satisfaction and responds promptly to voided and identified concerns regarding care coordination. Escalates issues to other departments as appropriate.
Assures compliance with the Department of Public Health, The Joint Commission, CMS, and other regulatory agencies.
Collaborates with the team in development of the patient's plan of care and educational needs.
Guides the multidisciplinary team members in the patient's progression through the care continuum
Participates in data collection and data analysis regarding patient through put.
Assists with implementation of protocols, clinical guidelines, and patient's plan of care.
Assists patients and families in understanding medical recommendations and the discharge plan.
Collaborates with social service and nursing staff in discussing the availability of community resources.
Partners with physicians to develop and implement the post-acute plan of care.
In collaboration with the multi-disciplinary team and, if applicable, post discharge services; coordinates or serves as a resource in the discharge process and ensures that the patient and family understand the discharge plan.
Documents assessments, actions and patient outcomes as indicated by department work processes.
Participates in patient education and documentation of that education specifically related to governmental regulations.
In the event of a Medicare Appeal by a patient, Case Management would reassess the patient, determine any opportunities for care or education, and work with the Multidisciplinary Team to reevaluate the plan of care.
Performs patient assessments through the systematic collection and review of patient- specific data and communicates assessments appropriately.
Assesses patient/family learning needs, plans, and provides education and evaluates the effectiveness of teaching in achieving desired outcomes.
Identifies and responds appropriately to ethical issues in patient care; provides nursing care and intervention in a non-judgmental manner that respects patient diversity and acknowledges patient rights.
Qualifications
Required
Graduate of an accredited school of professional nursing
Three or more years of experience in acute care nursing, including inpatient and outpatient
Licensed to practice as a Registered Nurse in the state of Illinois
Preferred
Bachelor of Science in Nursing
Case Management, Utilization Management, Discharge Planning, or related experience
Equal Opportunity
Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
Northwestern Medicine