RN Care Manager Float, 40 Hours (4-10hrs shifts / Days / Every 6th Weekend)

bmc; Boston (MA); Sur place; USD 90 000 - 120 000; Plein temps

Résumé du poste

bmc in Boston is seeking an RN Care Manager Float to assess, plan, implement, and evaluate care across the continuum, promoting quality and cost-effective outcomes. This role involves coordinating with physicians and nurses, managing a designated caseload, facilitating discharge, and ensuring timely authorization and meticulous documentation.

The position emphasizes collaboration with the multidisciplinary team to ensure high-quality, efficient, and patient-focused care in a full-time 40-hour

Responsabilités

• Conduct a thorough evaluation of the client's health, psychosocial, environmental, and financial status.
• Advocate for the client and seek authorization for care management from the recipient of services.
• Coordinate care progression across the continuum with physicians, nursing, and the care team.
• Ensure appropriate clinical pathway assignment by staff nurses.
• Identify and resolve barriers to discharge and delays in care.
• Collaborate with disciplines to expedite care and discharge planning.
• Maintain documentation and communicate with third-party payers and the care team.
• Apply utilization acuity criteria to monitor admissions and stays.
• Monitor length of stay and resource use to improve efficiency.

Description du poste

POSITION SUMMARY

Utilizing a collaborative process, the care manager will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost-effective outcomes. The care manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the patient and the reimbursement source.

The care manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include:

Assessment - The care manager will collect in-depth information about a person's situation and functioning to identify individual needs in order to develop a comprehensive care management plan that will address those needs.

Planning - The care manager will determine specific objectives, goals, and actions as identified through the assessment process. The plan should be action oriented and time specific.

Implementation - The care manager will execute specific intervention that will lead to accomplishing the goals established in the care management plan.

Coordination - The care manager will organize, integrate, and modify the resources necessary to accomplish the goals established in the care management plan.

Monitoring - The care manager will gather sufficient information from all relevant sources in order to determine the effectiveness of the care management plan.

Evaluation - At appropriate and repeated intervals, the care manager will determine the plan's effectiveness in reaching desired outcomes and goals. This process might lead to a modification or change in the care management plan in its entirety or in any of its component parts.

Position

Position: RN Care Manager Float Position

Department

Department: Case Management

Schedule

Schedule: Full Time - 40 Hours Days, with rotating weekends

ESSENTIAL DUTIES AND RESPONSIBILITIES

Conduct a thorough and objective evaluation of the client's current status including physical, psychosocial, environmental, financial, and health status expectation. As a client advocate, seek authorization for care management from the recipient of services (designee). Coordinates/facilitates patient care progression throughout the continuum.

Works collaboratively and maintains active communication with physicians, nursing, and other members of the multidisciplinary care team to effect timely, appropriate patient management.

Ensures appropriate clinical pathway assignment by staff nurses

Addresses/resolves system problems impeding diagnostic or treatment progress.

Proactively identifies and resolves delays and obstacles to discharge.

Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.

Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.

Collaborates with the physician and all members of the multidisciplinary team to facilitate care 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; facilitates the following on a timely basis:Completion and reporting of diagnostic testingCompletion of treatment plan and discharge planModification of plan of care, as necessary, to meet the ongoing needs of the patientCommunication to 3rd party payers and other relevant information to the care teamAssignment of appropriate levels of careCompletion of all required documentation in TQ screens and patient records

Maintain communication and collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting. Completes utilization management and quality screening for assigned patients.

Applies approved utilization acuity criteria to monitor appropriateness of admissions and continued stays and documents findings based on department standards.

Identifies at-risk populations using approved screening tool and follows established reporting procedures

Monitors length of stay (LOS) and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.

Assess resource utilization and cost management; the diagnosis, past and present treatment; prognosis, goals (short-and long-term).

Refers cases and issues to physician advisor in compliance with department procedures and follows up as indicated.

Communicates with resource center to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.

Uses quality screens