Case Manager

Appalachian Regional Healthcare (ARH); Georgia; On-site; USD 70,000 - 100,000; Full time

Job summary

Appalachian Regional Healthcare is seeking a Case Manager to coordinate care across a continuum for selected patient populations, leading a multidisciplinary team toward optimal quality, clinical and cost outcomes. You will facilitate resources, support discharge planning, and ensure adherence to payer guidelines throughout the patient journey.

The role requires collaboration with physicians and staff to implement care plans, monitor progress, and adjust plans daily to meet patient needs within

Qualifications

• BSN preferred with 5 years experience in a hospital/community setting.
• Must complete BSN or degree in other related field within 5 years.
• RN with MSN or degree in other related field with 3 years experience.

Responsibilities

• Coordinate care with physicians, multidisciplinary team and other health care professionals.
• Develop and maintain standards and procedures compliant with ARH policies and regulations.
• Maintain up-to-date knowledge to recommend new services, products and equipment.
• Assess and monitor comprehensive plan of care with patient and family involvement.
• Revise plan of care daily based on patient condition.
• Assume accountability for care plan effectiveness and outcomes.
• Evaluate level of care, diagnostics, and documentation for quality.
• Adhere to ISDA criteria and determine suitability of level of care on admission data.
• Develop, implement, monitor and evaluate clinical pathways and variances.
• Monitor patient progression through pathways.
• Communicate with patients, families, staff and payors as needed.
• Educate patients and families before admission, during stay and after discharge.
• Explain third-party payer guidelines and arrange discharge planning referrals.
• Foster positive work climate and support team effort.
• Assist in collecting and analyzing outcome data.
• Performs other duties as assigned.

Skills

Communication

Organizational skills

Travel required

Discharge planning

Infection control

Education

BSN preferred

RN with MSN

MSN or related degree

Job description

Overview

The Case Manager is accountable for coordinating the care and service of selected patient population across a continuum of care; ensuring and facilitating the achievement of optimal quality, clinical and cost outcomes; coordinating services and resources needed by the patient and family; and assuming a leadership role with the multidisciplinary team.

Responsibilities

• Coordinates and collaborate with physicians, provider, multidisciplinary team and other health care professionals concerning patient’s goals, plan of care and progress.
• Develop, implement, interpret and maintain work standards and procedures that are in compliance with ARH’s policies and governmental regulations and various regulatory agency requirements.
• Maintain up-to-date knowledge in the field to allow recommendation of new services, products and equipment.
• Assesses, develop, implementation, and monitors comprehensive plan of care through an interagency multi-disciplinary team process in conjunction with the patient and family internal and external settings.
• Revise and adjust on a daily basis the plan of care to accommodate the needs of the individual patient based on continuing assessment of patient condition.
• Assumes responsibility and accountability for the care plan and effectiveness and patient outcomes.
• Assesses the appropriateness of the level of care; diagnostic testing and clinical procedures; quality and clinical risk issues; and documentation of medical record completeness.
• In accordance with hospital sanctioned ISDA criteria and/or other established criteria, reviews all patient admission data to determine the suitability of the level of care.
• Develop, implement, monitor and evaluate clinical pathways and clinical pathway variances.
• Monitor patients progression through clinical pathways.
• Communicates continually with patients, families, medical staff, caregiver and third-payors as necessary.
• Assist the patients and families with the educational process prior to admission, during hospital stay and after discharge, as indicated.
• Assures patients understand the third-party payer guidelines and to arrange discharge planning referrals as ordered by patients’ physicians.
• Develops and maintains a positive work climate and supports the overall team effort of the hospital.
• Assists in collecting and analyzing outcome data.
• Performs other duties as assigned or directed.

Qualifications

Education

• BSN preferred with 5 years experience in a hospital/community setting; OR
• Must complete BSN or degree in other related field within 5 years; OR
• RN with MSN or degree in other related field with 3 years experience;

Licenses & Certifications

• Must meet all Licensure and Certification requirements in state working; OR
• Must obtain Certification of Case Management Society of America.
• Must have a valid driver's license in state working.

Required Skills, Knowledge & Abilities

• Excellent oral and written communication skills.
• Must possess skill and proficiency in applying highly technical principles, concepts and techniques that are central to the nursing profession.
• Excellent organizational skills.
• Must travel to patients' residences, agencies, and network providers as necessary.
• Required to be cross-trained in UR, QA, discharge planning, and infection control.