Case Manager

UHC United Hospital Center; États-Unis; Sur place; USD 60 000 - 90 000; Plein temps

Résumé du poste

WVU Medicine is seeking a skilled nurse to lead transition/discharge planning for an assigned patient load. You will coordinate with the multidisciplinary team to ensure timely, patient-centered care and develop individualized plans with physician collaboration.

You will educate staff, patients, and families about the transition process, document progress, and assist with end-of-life decisions and financial coordination when needed.

Qualifications

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state RN license through the enhanced Nurse Licensure Compact (eNLC).
• Three (3) years clinical experience.

Responsabilités

• Manages all aspects of transition/discharge planning for assigned patients in a timely manner.
• Collaborates with the multidisciplinary team to facilitate the transition/discharge process for designated caseload.
• Monitors patient progress and ensures the plan of care is patient-focused, high quality, efficient, and cost effective.
• Provides education to staff, physicians, patients and families for effective transition planning.
• Faces with patient/family to assess needs and develop individualized transition/discharge plans with physician input.
• Communicates with the team and post-acute providers about complex family dynamics impacting care.
• Initiates and facilitates referrals to post-acute services (homecare, DME, hospice, LTAC, rehab, SNF).
• Documents interactions and progress according to policy.
• Assists with completion of advanced directives and power of attorney forms.
• Coordinates financial/benefits assistance and entitlement referrals as needed.
• Uses electronic quality screens to identify delays and readmissions.
• Completes clinical reviews and applies utilization criteria for admissions and stays.

Connaissances

RN license

Clinical experience

Formation

BSN

Description du poste

Welcome! We’re excited you’re considering an opportunity with us!

MINIMUM QUALIFICATIONS:

• EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
• EXPERIENCE: 1. Three (3) years clinical experience.

PREFERRED QUALIFICATIONS:

• EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Bachelor’s degree in Nursing (BSN)

CORE DUTIES AND RESPONSIBILITIES:

• Manages all aspects of transition/discharge planning for assigned patients in a timely manner.
• Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload.
• Monitors the patient’s progress; intervening as necessary and appropriate, to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
• Provides education as needed to staff, physicians, and patients and their families to ensure effective transition planning.
• Meets directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team.
• Communicates with the multidisciplinary team and post-acute providers when applicable, any complex family dynamics that may directly impact patient care and transition/discharge planning.
• Initiates and facilitates referrals to post-acute services- including but not limited to: Homecare, Durable Medical Equipment, Hospice Care, Long Term Acute Care Facilities, Acute Rehab Facilities, and Skilled Nursing Facilities.
• Communicates all necessary information regarding transition/discharge plan to the multidisciplinary team, patient and family.
• Provides timely and comprehensive documentation of interactions with patient and/or families and all transition/discharge planning activities and progress according to departmental policy.
• Assists patient/families with completion of medical power of attorney, health care surrogate, and advanced directives
• Collaborates for appropriate resource and financial management which may include but is not limited to: financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination
• Utilizes quality screens in the electronic record to identify potential issues including but not limited to- avoidable delays and readmissions.
• Completes clinical reviews for patients.
• Applies approved utilization criteria to ensure medical necessity of patient’s admissions and continued stays, and documents the findings based on department standards, policy and procedure.
• Screens for appropriate authorization and level of care.
• Facilitates covered day reimbursement certification for assigned patients and discusses payor criteria and issues on a case by case basis with clinical staff (ie. Peer to Peer) and follows up to resolve problems with payors as needed.
• Educates hospital staff and physicians to payer regulations and managed care principals to prevent denials.
• Fosters the integration of staff and/or students into the healthcare team.

For facilities with specialty accreditation requirements:

• Completion of annual required education related to specialty accreditation as defined by accreditation standards. Training may be completed through CBLs, trainings, In-services, and competency validation.

PHYSICAL REQUIREMENTS:

• Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling are necessary body movements utilized in performing nursing duties throughout the work shift.
• Must be able to lift, move, and position patients of all weights, with varying amounts of assistance in a fair manner on a regular and recurring basis.
• Hearing within a normal range required (e.g., to assess breath sounds, heart sounds, apical pulse, monitors, etc.).
• Visual acuity must be within normal range. Must be able to perform night driving as necessary for patient care.
• Must be able to perform heavy work; exerting in excess of 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.

WORKING ENVIRONMENT:

• Working closely with others.
• Working protracted or irregular hours.
• Working around biohazards.
• Working around infectious diseases.
• Working with hands in water.
• Working with electrical hazards associated with patient care equipment.

SKILLS AND ABILITIES:

• Knowledge of patient’s current medical insurance coverage and limitations and the precertification requirements for Durable Medical Equipment (DME), post-acute placements, infusions, transfers etc
• Knowledge of relevant scientific principles, established standards of care and/or research findings.
• Knowledge of procedures and techniques involved in administering routine and special treatments to patients.
• Knowledge of and appropriate application of the nursing process.

Additional Job Description:

• Scheduled Weekly Hours: 36
• Shift: Day (United States of America)
• Exempt/Non-Exempt: United States of America (Exempt)
• Company: UHC United Hospital Center
• Cost Center: 405 UHC Quality Management Address: 327 Medical Park Drive Bridgeport West Virginia

Equal Opportunity Employer West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

The West Virginia University Health System is a West Virginia-based academic health system that provides the full continuum of healthcare services at 30 hospitals in West Virginia, Pennsylvania, Ohio, and Maryland. With more than 47,000 employees, of which 7,200 are providers, and $10 billion in total operating revenues, the WVU Health System is anchored by an 890-bed academic medical center and the 150-bed WVU Medicine Golisano Children’s Hospital in Morgantown, West Virginia. Together, the Health System’s hospitals, clinics, and specialty programs provide a comprehensive continuum of care, ranging from community-based primary and specialty services to highly complex, quaternary care and post-acute care.