Provides coordination and lateral integration between management and patient care activities that are consistent with the Magis Patient/Family Centered Model to achieve high standards of patient care and quality outcomes.
The Case Manager works with the multidisciplinary team including physicians, staff and payers to ensure patient's progress along the continuum of care in an efficient and cost effective manner that ensures quality outcomes. Utilizes established guidelines to support appropriate level of care throughout hospitalization.
Acts as a patient advocate and communication link with other departments and community resources. Facilitates multidisciplinary rounds and supports nursing staff in development of individualized, evidence-based, outcomes oriented, and safe practice.
Uses approved criteria for admission and continued stay reviews to ensure appropriate setting and timely implementation of plan of care. 1. Monitors patient's progress across the continuum and intervenes as necessary to ensure quality services that are efficient and cost effective. 2.
Collaborates with admitting physician regarding appropriate level of care. 3. Consults with Physician Advisor and administrative leadership as necessary to resolve barriers regarding progression of care. 4. Knowledgeable of Medicare, Medicaid and 3rd party payers relative to patient care requirements. 5.
Responds to requested insurance reviews based on contractual obligations. 6. Actively manages concurrent denials.
Reviews pertinent clinical information to assess patient's response to treatment and care. 1. Consults with physicians and other healthcare providers to ensure patient progress towards discharge. 2. Knowledgeable and utilizes latest evidence-based clinical practices to support patient care.
Responsible for patient assessment of complex clinical discharge needs and establishment of an appropriate plan of care with multidisciplinary team. 1. Demonstrates critical thinking skills and oversees the care coordination of defined population. 2.
Ensures that patient goals are set with patient/family, negotiates healthcare resources and educates patient/family regarding available options of care throughout the continuum. 3. Demonstrates clinical competence to care for a specific patient population. 4. Conducts daily multidisciplinary rounds demonstrating ability to identify and address care coordination barriers. 5. Facilitate patient education for safe and effective discharge.
Demonstrates leadership behaviors that enhance and support team functions. 1. Mentors and coaches staff. 2.
Maintains competencies and participates in continuing education for self and development of colleagues and students. 3. Participates in delivering professional programs/ courses/inservices, internal and/or external, and community events. 4. Seeks opportunities to promote staff education, certification, clinical ladder and award programs. 5.
Maintains national certification, as applicable, and membership in professional organization(s). 6. Creates opportunities to advocate for the role of the professional nurse as a key member of the interdisciplinary team.
III. Position Requirements:
Minimum Education: .
Required: Bachelors Degree OR equivalent training acquired via work experience or education
Preferred: Masters Degree
Specify Degree(s): Nursing
Required: 3-5 years of previous job-related experience
Preferred: 6-10 years of previous job-related experience
Details: Recent clinical experience in medicine, surgery, critical care, telemetry, or ED is required. Recent Case management experience is preferred.
Required: Current Registered Nurse License State of Illinois
Preferred: CPR (Cardiopulmonary Resuscitation)
Other: Case Management certification expected within 2 years of hire.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.
Trinity Health Corporation