Case Manager

Appalachian Regional Healthcare (ARH); Hazard (KY); On-site; USD 65,000 - 85,000; Full time

Job summary

Appalachian Regional Healthcare (ARH) is seeking a Case Manager to coordinate care across the continuum, ensuring optimal quality and cost outcomes. You will collaborate with physicians and the care team to develop and monitor comprehensive plans of care for patients and families.

The role requires a BSN or RN with advanced degree and relevant experience, plus certification in case management and driving to patient homes or facilities as needed.

Qualifications

• BSN preferred with 5 years experience in a hospital/community setting.
• 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.
• Certification by the Case Management Society of America is required.
• Must have a valid driver’s license in state working.

Responsibilities

• Coordinates and collaborate with physicians, provider, multidisciplinary team on patient goals, plan of care and progress.
• Develop and maintain work standards and procedures in compliance with ARH policies and regulations.
• Maintain up-to-date knowledge to recommend new services, products and equipment.
• Assess, develop, implement and monitor comprehensive care plans with patient and family.
• Adjust the plan of care daily based on ongoing assessment and patient needs.
• Assume responsibility for the care plan, outcomes and effectiveness.
• Assess level of care appropriateness, testing, procedures and documentation.
• Review admission data to determine level of care suitability.
• Develop, implement and evaluate clinical pathways and variances.
• Monitor patient progression through clinical pathways.
• Communicate with patients, families, medical staff and payors as necessary.
• Assist patients and families with education pre-admission, during stay and after discharge.
• Explain third-party payer guidelines and arrange discharge planning referrals as ordered.
• Support a positive work climate and team effort at the hospital.
• Assist in collecting and analyzing outcome data.
• Perform other duties as assigned.

Skills

Communication

Organization

Travel

UR/QA/Discharge

Education

BSN preferred

RN with MSN

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.

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.

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.