Senior Case Manager II

University of Maryland Medical System; Baltimore (MD); On-site; USD 70,000 - 90,000; Full time

Job summary

The University of Maryland Medical System in Baltimore is seeking a Case Manager to provide patient care coordination and discharge planning. This role requires licensure as a Registered Nurse in Maryland and a BSN, along with a minimum of 2 years of case management experience. The Case Manager works closely with a multidisciplinary team to assess individual needs and facilitate effective transitions of care, playing a crucial role in managing patient outcomes. The position offers a Monday to Friday schedule with potential weekend rotations.

Qualifications

• Must possess 2 years of experience as a case manager.
• Current and active specialty certification is preferred.
• Knowledge of discharge planning and case management is required.

Responsibilities

• Coordinate care and discharge planning for assigned patients.
• Collaborate with multidisciplinary teams to ensure patient needs.
• Manage length of stay and reduce readmissions.

Skills

Knowledge of managed care

Verbal and written communication skills

Analytical skills

Team building skills

Ability to work independently

Education

BSN or equivalent healthcare degree

Licensure as a Registered Nurse in Maryland

Tools

Hospital/Case Management related software

Job description

General Summary

Under general supervision of the Manager of Case Management, the Case Manager provides care coordination and discharge planning for an assigned patient case load. The Case Manager will assess individual patients’ needs, coordinate and implement plans of care and monitor and evaluate outcomes across the continuum of care.

Principal Responsibilities And Tasks

• Assesses assigned patients and integrates psycho social assessment within the multidisciplinary team. Works collaboratively with the multi-disciplinary team to determine potential and actual risks to recovery and formulates plan to determine appropriate level of care upon disposition from the acute care setting.
• Accountable for developing and coordinating the implementation of Discharge Plan A and alternative Plan B, including documentation in the medical record.
• Multidisciplinary collaboration with physicians, nursing, social work, and multiple disciplines, departments, payers, and agencies to eliminate barriers to efficient delivery of care in the appropriate setting.
• Facilitates timely transition plan.
• Active leadership role in the ongoing management of inpatient length of stay and the reduction of readmissions across the organization.
• Integrates work with ambulatory and clinic transitional case managers.
• Leadership in care management rounds, interprets, and integrates the patient’s story into the overall multidisciplinary plan of care.
• Develops and implements corrective action plans for resolution of complex problematic issues and elevates to leads as necessary.
• Ensures authorizations have been completed in a timely manner.
• Collaborates with Utilization Management and synthesizes information in order to reduce avoidable days.
• Collaborates with Physician Advisor for complex issues.
• Guides physicians in appropriate clinical documentation.
• Actively participates in clinical performance improvement activities as assigned.
• Builds a network of positive working relationships that advocate for the patient.
• Remains current on clinical practice and protocols impacting clinical reimbursement.
• Participates in department improvement initiatives.
• Serves to orient and educate Case Manager 1s to departmental practices.
• Provides oversight and education to case management interns placed in the practice area.
• Participates in at least one of the following professional growth and development activities:
  • Certified in a specialty area.
  • Matriculation or completion of a degree or certificate program (post-baccalaureate 12 credits or more).
  • Formal teaching.
  • Member of a professional association board or committee.
  • Peer reviewers for a professional journal (minimum of 2 per year).
• Participates in leadership activities:
  • Demonstrates expertise in best practice and care management core competencies.
  • Supports management in development and implementation of work flows and clinical practices.
  • Supports manager in the development and oversight of clinical and operational guidelines and policies.
  • Leads and promotes best practice in day to day operations of practice area.
  • Serves as a resource expert to other departments in an area of expertise.
  • Provides formal training, education or consultation to other departments.

Knowledge, Skills and Abilities

• Knowledge of managed care, discharge planning and case management is required.
• Highly effective verbal and written skills are required.
• Strong communication skills, self confidence and experience dealing physicians required.
• Excellent analytical and team building skills, as well as the ability to prioritize and work independently is required.
• Must possess the ability to work collaboratively with other disciplines.
• Ability to work with Hospital/Case Management related software programs required.
• Ability to demonstrate knowledge and skills necessary to provide care appropriate to the patient population(s) served. Ability to demonstrate knowledge of the principles of growth and development over the life span and ability to assess data reflective of the patient's requirements relative to his or her population-specific and age specific needs.

Patient Safety

• Takes action to correct observed risks to patient safety.
• Reports adverse events and near misses to appropriate management authority.
• Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.

Education and Experience

• Licensure as a Registered Nurse or other equivalent health care license in the state of Maryland required.
• Must hold a BSN or equivalent health care degree.
• A minimum of 2 years of experience as a case manager is required.
• Current and active specialty certification is preferred.

Additional Information

• All your information will be kept confidential according to EEO guidelines.
• Work Schedule: Monday- Friday 8am-4:30 pm with weekend rotation.