Case Manager, RN

Northern Westchester Hospital Manhasset , NY 11030

Posted 3 weeks ago

Job Description:

Serves as liaison between the patient and facility/physician. Ensures a continuum of quality patient care throughout hospitalization and oversees provisions for patient's discharge. Assesses, plans, oversees and evaluates the appropriateness of care throughout admission and hospitalization of the patient.

Responsibilities Include:
1.Facilitates patient management throughout hospitalization.

  • Participates in patient management rounds and patient centered meetings.

  • Identifies potential delays and resolves issues with appropriate departments.

  • Identifies appropriate utilization of Social Work Services and makes referrals when appropriate.

  • Confers with physician regarding referrals for Physical Therapy, nutrition, speech and swallow.
    2.Serves as an in-patient liaison - planning, assessing, implementing and evaluating patient in collaboration with the health care team.

  • Serves as a resource to the health care team regarding quality, utilization of clinical resources, payer, and reimbursement issues.

  • Works with on-site screeners in transitioning patients to appropriate post discharge settings.

  • Collaborates with payers, providing all necessary clinical documentation for the maximization of benefits.

  • Serves as a liaison to patient, family, admitting, primary care physician, health care team, and hospital departments.

  • Collaborates with and provides feedback to the primary care physician and multidisciplinary team regarding patient's status with regard to length of stay, utilization of resources and discharge status.
    3.Provides support to the in-patient health care team as well as to patient and family regarding all aspects of admission, hospitalization and discharge plan.

  • Involves patient and/or family in discussion and planning for anticipated need for care following discharge.

  • Ensures patient and/or family are given information regarding their choices regarding transferring the patient to another level of care according to regulatory standards.
    4.Performs concurrent utilization management using Interqual criteria.

  • Conducts chart review for appropriateness of admission and continued length of stay.

  • Contacts and interacts with third party payers to obtain approval of hospital days, pre-certification and post-discharge eligibility in relation to clinical course.

  • Ensures compliance with current state, federal, and third party payer regulations.

  • Identifies patients for Alternate Level Care (ALC) care list and notifies appropriate health team members.

  • Communicates with insurance companies and physicians regarding utilization issues.

  • Utilizes important message from Medicare (IMM) when appropriate.

  • Ensures managed care reviews are up to date and accurately reflect patient's clinical progress and acute needs.
    5.Participates in the quality management of patient care outcomes.

  • Submits data to management regarding case management and/or quality initiatives.

  • Participates in data collection regarding patient's length of stay, utilization of clinical resources, IPRO citations including appropriate recommendations and re-admission within 30 days.
    6.Initiates appropriate discharge planning as supported by initial assessment at time of admission.

  • Reviews patient's chart.

  • Assesses each patient physically, psychosocially and financially.

  • Assesses patient's support system to facilitate appropriate discharge to community.

  • Substantiates, with the physician, the need for home care services.

  • Coordinates procurement of any supplies, equipment or home lab work needed by patient to evaluate discharge.

  • Arranges for post-hospital transportation, when indicated.

  • Interacts and coordinates with community agencies, families, vendors facilities and institutions to facilitate patient discharge.
    7.Documents the case management process in the medical record.

  • Completes and documents a psychosocial assessment on the patient.

  • Documents on-going processes of patients' hospitalization.

  • Documents finalized discharge plan and disposition.

  • Completes applicable areas of the Patients Discharge Instruction Sheet and the Patient Transfer Sheet.

  • Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile of the patient.

  • Ensures case management sheet is current and accurate.
    8.Performs related duties, as required.

Qualifications

  • Bachelor's Degree in Nursing, required.

  • Current license to practice as a Registered Professional Nurse in New York State.

  • Case Management Certification, preferred.

  • Minimum of one (1) year related experience, required. Experience in case management and clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred.

  • Keeps abreast of developments in the field and serves as a resource to other staff.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Assistant Nurse Manager (Weekends) Periop RN Experience Required

Northern Westchester Hospital

Posted 2 days ago

VIEW JOBS 4/19/2019 12:00:00 AM 2019-07-18T00:00 Job Description Assumes responsibility for the overall assessment, planning, implementation and evaluation of patient care on the unit. Carries out the System, Hospital and Nursing Service mission, vision, values and the overall strategic planning, clinical management, patient care, budgeting, financial management and quality management on the unit. Promotes the health system service standards and creates a patient focused caring environment while addressing and meeting the individual needs of the patient. Fosters an environment of collaboration and respect with physician colleagues, nurses and other healthcare team members. Responsibilities Include: 1. Standards Compliance * Maintains current knowledge of and ensures compliance with all regulatory and professional standards of care which includes JCAHO, CMS, IHI, CAP, etc. * Utilizes creativity in developing quality/performance improvement programs, instructing staff and implementing new and improved standards. * Utilizes results from \u201ctracer\u201d methodology tools to develop corrective action plans to ensure that quality of care is embedded into clinical practice on an ongoing basis. 2. Operational Performance * Develops, prepares and monitors the personnel, supply and equipment budgets in collaboration with the staff and support department directors. * Develops long-term unit staffing schedules and ensures adequate daily coverage in accordance with established staffing needs. * Develops measures and monitors unit operational performance metrics inclusive of LOS, agency and overtime costs, vacancy and turnover rates. 3. Clinical Practice/Patient Care * Collaborates with the Nurse Executive to establish nursing care standards and evaluates staff compliance. * Identifies research protocols effecting the patient population served and keeps nursing staff informed. * Facilitates the effective provision of support services essential to patient care. * Maintains a safe and caring environment for patients that is conducive to positive health teaching, and maintenance; patient and family expectations of care; develops mechanism to assess same. * Develops unit goals and objectives to support the institutional values and goals, with input from staff. * Recognizes the need for patient care to be delivered in a culturally sensitive manner and role models sensitivity to staff. 4. Management * Participates in the overall planning process for the service. * Responsible for the overall planning process for the unit. * Uses findings from patient satisfaction survey and with input from the staff, to establish unit based customer services agenda. * Uses findings from staff satisfaction survey and with input from the staff, to establish a unit based recruitment and retention agenda. * Develops an effective plan for delivery of nursing care within the assigned area of responsibility. * Responds to patient and family concerns or complaints with sensitivity and compassion in a timely fashion. * Conducts monthly meetings with the staff to address equipment, scheduling, goals and objectives, performance metrics and improvement activities, and any staff concerns. 5. Human Resource Development/Management * Hires, educates and evaluates staff. * Works with Human Resources to counsel, discipline and terminate staff as needed. * Educates staff in new and existing department procedures and systems (e.g. information systems, fiscal responsibility, etc). * Makes recommendations and provides opportunities for growth and development of personnel and arranges for appropriate education and training. Is able to identify at least one potential successor to the Nurse Manager role * Creates and maintains a supportive working environment for all staff, and students. * Demonstrates self-development and keeps current on a variety of clinical management and health care topics. * Completes the CLI Core Management Series and appropriate management conferences. * Responds in a timely fashion to staff concerns and functions proactively to retain staff * Establishes unit metrics and goals to measure effectiveness of retention strategies. * Creates and maintains an atmosphere of respect and courtesy toward patients, staff and colleagues. * Employs learning organization principles and techniques in all aspects of unit leadership * Promotes a level of professionalism on the unit. Motivates academic pursuit and continuing education on the part of the staff by establishing and meeting service based professional certification goals. 6. Interactive Relationships * Promotes empowerment of the staff by utilizing collaborative approaches and encouraging new ideas. * Participates as member of healthcare team and various interdisciplinary committees to improve patient care and meet patient needs. * Promotes collegial relationships based on mutual respect and support. 7. Performs related duties, as required. Qualifications * Bachelor's Degree in Nursing, required. Master's Degree, preferred. * Current license to practice as a Registered Professional Nurse in New York State. * Minimum of three (3) years nursing experience including previous supervisory experience. * Demonstrated leadership, communication and interpersonal skills required. Northern Westchester Hospital Manhasset NY

Case Manager, RN

Northern Westchester Hospital