SAH RN Case Manager EX

Brown-University-Health-1; Fall River (MA); On-site; USD 80,000 - 105,000; Full time

Job summary

Brown University Health seeks an experienced case management nurse to coordinate patient care across the continuum and manage resources effectively.

The role emphasizes collaboration with medical staff, nursing and therapeutic disciplines to develop and implement patient care plans, ensure timely discharges and adherence to third party payor guidelines. Strong communication with managed care and external reviewers is essential.

Responsibilities

• As needed, strives to maximize and mobilize all internal and external resources that facilitate the case management process for all assigned cases
• Documentation always reflects patient plan of past hospital care and if applicable interdisciplinary coordination
• As needed, provides a nursing assessment within 24-48 hours of patient admission for clinically oriented services focused on mobilizing primary care physician, hospital systems, patient/family and community resources directed towards facilitating a clinically safe and timely discharge
• Identifies problems and gaps in patient care when covering for unit case manager.
• Suggested interventions, expedited interdisciplinary referrals and ensured diagnostic testing is completed and reported within appropriate timeframe
• Actively participates in patient care conferences as scheduled on nursing units when covering for the unit case manager
• Works collaboratively with medical staff, nursing and other therapeutic disciplines in developing and implementing a patient plan of care while covering for case manager.
• Follows plan of care initiated by unit case manager.
• Initiates initial plan of care for new patients assigned.
• Clinically documents patient plan of care, progress, goals, and interventions according to Case Management Department, Federal, and State guidelines.
• Maintains a professional working relationship with Managed Care Organization telephonic and on site reviewers and external reviewing agencies in monitoring course of hospitalization and need for post hospital services according to third party payor guidelines.
• Returns all calls from managed care organizations occurring on day covering the case.
• Community health care agencies and third party payor utilization review agencies are provided with patient care information through allscripts that is concise, accurate and communicated in a timely manner.
• All reviews assigned to per diem case manager sent when completed unless review referred for second level review.
• Exercises professional authority intervening when necessary, with physicians /therapeutic disciplines to remove barriers that impact length of stay.
• Communicates via allscripts to unit case manager any issues identified while covering unit
• Always demonstrates awareness of over or under utilization of resources and responds accordingly
• Appropriately monitors utilization of resources for caseload assigned
• Demonstrates understanding and has accurately applied severity of illness Intensity of service criteria according to third party payor guidelines, appropriately identifying levels of care for all assigned cases.
• Maintains ongoing dialogue with medical staff, nursing and other involved therapeutic disciplines relative to utilization and length of stay issues and communicates via Allscripts to unit case manager
• Demonstrates initiative in exploring strategies to reduce length of stay

Job description

SUMMARY:

Promotes the development of high quality patient care in the most effective setting, balancing patient/hospital advocacy. Knowledgeable of third party payor issues.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

• Instill Trust and Value Differences
• Patient and Community Focus and Collaborate

RESPONSIBILITIES:

KEY RESPONSIBILITIES:

Coordinates patient care across the continuum of care:

• As needed, strives to maximize and mobilize all internal and external resources that facilitate the case management process for all assigned cases
• Documentation always reflects patient plan of past hospital care and if applicable interdisciplinary coordination
• As needed, provides a nursing assessment within 24-48 hours of patient admission for clinically oriented services focused on mobilizing primary care physician, hospital systems, patient/family and community resources directed towards facilitating a clinically safe and timely discharge
• Identifies problems and gaps in patient care when covering for unit case manager.
• Suggested interventions, expedited interdisciplinary referrals and ensured diagnostic testing is completed and reported within appropriate timeframe
• Actively participates in patient care conferences as scheduled on nursing units when covering for the unit case manager
• Works collaboratively with medical staff, nursing and other therapeutic disciplines in developing and implementing a patient plan of care while covering for case manager.
• Follows plan of care initiated by unit case manager.
• Initiates initial plan of care for new patients assigned.
• Clinically documents patient plan of care, progress, goals, and interventions according to Case Management Department, Federal, and State guidelines.
• Maintains a professional working relationship with Managed Care Organization telephonic and on site reviewers and external reviewing agencies in monitoring course of hospitalization and need for post hospital services according to third party payor guidelines.
• Returns all calls from managed care organizations occurring on day covering the case.
• Community health care agencies and third party payor utilization review agencies are provided with patient care information through allscripts that is concise, accurate and communicated in a timely manner.
• All reviews assigned to per diem case manager sent when completed unless review referred for second level review.

Monitors utilization of resources:

• Exercises professional authority intervening when necessary, with physicians /therapeutic disciplines to remove barriers that impact length of stay.
• Communicates via allscripts to unit case manager any issues identified while covering unit
• Always demonstrates awareness of over or under utilization of resources and responds accordingly
• Appropriately monitors utilization of resources for caseload assigned
• Demonstrates understanding and has accurately applied severity of illness Intensity of service criteria according to third party payor guidelines, appropriately identifying levels of care for all assigned cases.
• Maintains ongoing dialogue with medical staff, nursing and other involved therapeutic disciplines relative to utilization and length of stay issues and communicates via Allscripts to unit case manager
• Demonstrates initiative in exploring strategies to reduce length of stay