Facilitates, coordinates and integrates high quality, cost effective care delivered to patients across and episode of illness or throughout the entire continuum of health care delivery. Performs resource management, utilization management, discharge planning, care facilitation, referral to all levels of care, and related duties with a defined patient population, and as it relates to care management and the delivery of patient care services.
Communicates with payers addresses and resolves issues with other members of the health care team to enhance and created opportunities which positively impact clinical and cost outcomes. Carries out all responsibilities in accordance with the organization's core values, applicable policies, procedures, and civil laws.
1.Assesses, plans, implements, coordinates, monitors and evaluates activities related to the outcome of assigned patients in conjunction with the rest of the interdisciplinary health care team. Acts as a clinical resource/consultant/educator to all staff in the planning and delivery of patient care by assessing patients' individual needs and ensuring that the plan of care meets same.
2.Functions as a clinical resource/consultant/educator for interdisciplinary health care team on an ongoing basis in order to maximize quality of patient care and effectively manage length of stay by promoting a timely, cost-effective, efficient and safe discharge plan to include extended care, long-term care or home health services.
3.Assumes a leadership role in the interdisciplinary health care team in order to manage patient care with clients and their families, as well as the coordination thereof, to ensure high quality patient care throughout the hospital stay and upon discharge and documents interventions in the medical record.
4.Maintains regular contact with patient, family and interdisciplinary health care team to achieve clinical pathway and case management goals and ensures instruction to same based on individual learning needs.
5.Participates in team meetings and interdisciplinary rounds and incorporates recommendations and/or services of interdisciplinary team members in plan of care. Provides presentations and educational offerings to interdisciplinary health care team as it relates to case management.
6.Participates in data collection and analysis by completing case manager's worksheet and inputting variances into a Microsoft Access Database. Completes variance and outcome tracking reports according to the clinical pathways and maintains pertinent documentation and case information in appropriate patient records, reports and files.
7.Develops collaborative and professional relationships with patients/families, other departments, other members of interdisciplinary health care team, treatment providers and external health agencies to facilitate and support quality care.
8.Participates in the development, revision and effective utilization of the interdisciplinary clinical pathways for selected patient populations and other case management tools.
9.Participates in Performance Improvement (PI) activities by monitoring variances from expected outcomes in patient, caregiver, and system. Summarizes and interprets variance data to create a PI program that improves patient care.
10. Collaborates with the Head Nurse in order to assist in the supervision, education and development of her/his staff involved in the care of patients, as necessary.
11. Performs related duties as required.
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 five (5) years related health care experience, required. Minimum of (2) two years of case management experience, inpatient, HMO, insurance or other outpatient setting. One (1) year management experience, preferred.
Basic computer skills. Knowledge of Microsoft Office 97: Microsoft Word, Access and Excel, preferred.
Strong organizational and leadership skills.
Strong interpersonal skills.
Strong written and verbal communication skills. Ability to problem solve and prioritize using critical analysis skills. Ability to make highly competent professional judgments and decisions. Ability to function as a core member of an interdisciplinary team.