General Purpose of Job : The Case Manager works in partnership and in a leadership role with physicians and the interdisciplinary team to coordinate the care and service of selected patients across the continuum. This role’s underlying objective is to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates, coordinates and promotes efficient and effective utilization management, care facilitation and discharge planning functions. Knowledge, Skills and Experience: Education : High school diploma/GED Bachelor of Science in Nursing preferred License / Certification / Registration : Current and valid Michigan R.N. license Experience : Minimum of three years clinical nursing experience (acute care preferred) Skills & Abilities : Skill and proficiency in applying managed care principles and concepts to the case management process. Knowledge of and skill in the use of computers and related systems and software preferred. Skill in observation and critical thinking, demonstrated by effective decision making, and use of appropriate problem-solving methods. Skill in excellent interpersonal, oral, and written communications required. A high degree of professionalism is essential for all contact with patients, family members, clinical personnel, physicians, outside referral sources, and members of the community. Ability to make effective decisions, judgments and incorporate problem-solving methods. Ability to be persistent in working through and/or resolving issues and problems required. Ability to work independently and professionally, set priorities and take initiative while working efficiently and using good judgment required. Essential Duties : This job description is intended to cover the minimum essential duties assigned on a regular basis. Team members may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position. Utilization Management: Applies approved clinical appropriateness criteria for assigned patients to monitor appropriateness of admissions and continued stays, and documents findings accordingly based on policy. Evaluates for appropriate setting and level of care. Refers inappropriate observation or anticipated admission cases to the Physician Advisor. Explores strategies to reduce length of stay and resource consumption while maintaining optimal patient outcomes. Takes action to achieve continuous improvement in both areas. Obtains certification for unscheduled/emergency admissions, as directed by health plan. Negotiates with payors to get coverage for out-of-plan services. Collaborates with providers and ancillary departments to arrange the most cost-effective treatment plan. Reviews medical record for issues related to quality, risk management and appropriate utilization of services. Identifies potential denials or “No Bills” and develops a plan of action to address the issue with the Supervisor of Case Management. Functions as a resource for the principles of the managed care process for physicians and other disciplines and promotes case management through role modeling and education of the healthcare delivery team as related to the appropriate disposition for the patient. Discharge Planning: Assists with social work to coordinate/facilitate patient care progression throughout the continuum. Coordinates discharge plan with patient, family, physicians and inpatient/outpatient staff to assure an individualized, timely and effective transition to the next level of care. Continues to monitor and assess for discharge planning needs as appropriate. Collaborates and communicates with all members of the multidisciplinary team in all phases of discharge planning process; including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation. Monitors and evaluates effectiveness of the discharge planning process through outcome analysis across the continuum as appropriate. Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge. Addresses/resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge. Facilitates referrals and transfers to other facilities and resource needs as appropriate. Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary in the medical record to assure continuity of care. Participates in daily multidisciplinary rounds. Clinical Performance Improvement: Assists in the collection and reporting of resource and financial indicators including case mix index, LOS, avoidable days, readmission rates, denials and appeals. Collects delay and other data for specific performance and /or outcome indicators as determined by the Director of Care Management. Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data. Collaborates with medical staff, nursing staff and other members of the organization to eliminate barriers to efficient delivery of care in the appropriate setting. Supports and assists in facilitation of appropriate clinical documentation efforts. Other: Predictable and reliable attendance. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.
General Summary: The RN Staff Nurse is a professional care giver who assumes responsibility and accountability for a group of patients for a designated time frame and provides care to these patients via therapeutic use of self, the nursing process, the environment / instrumentation, and other health care team members. Assigns and directs the work of related staff. Requirements: Michigan Registered Professional Nurse licensure required. Bachelor of Science in Nursing preferred. Current Basic Life Support (BLS/CPR) provider—required. Previous experience in specialty preferred. Endoscopy RN: Current Advanced Cardiac Life Support (ACLS) provider preferred. Must obtain ACLS certification within 60 days of hire or placement in the unit. Level 4/Level 5 RN: Current Advanced Cardiac Life Support (ACLS) provider preferred. Must obtain ACLS certification within one year of hire or placement in the unit. Level 4/Level 5 RN: Competence in basic cardiac dysrhythmia interpretation required, will train. Level 6: Current Pediatric Advanced Life Support (PALS) provider preferred. ED: Current Pediatric Advanced Life Support (PALS) provider preferred. Must obtain PALS certification within six months of hire or placement in the unit. Advanced Cardiac Life Support (ACLS) certification within three (3) months after hire or transfer. Must maintain ACLS certification with re-certification every two (2) years. IR/NEURO IR RN: Current Advanced Cardiac Life Support (ACLS) provider required. HPE Infusion/Cancer Center Infusion RN: Must obtain ONS/ONCC Chemotherapy Immunotherapy Certificate prior to administering chemotherapy. Essential Functions and Responsibilities: ASSESSMENT—Assess the patient's condition and physical, psychological, cognitive, social, rehabilitative, and discharge needs. PLANNING—Develop a plan of care using nursing diagnoses and setting patient outcome goals. IMPLEMENTATION—Implement nursing plan of care and physician's orders. IMPLEMENTATION—Establish priorities of patient care based on essential patient needs and available resources of time, personnel, equipment and supplies. IMPLEMENTATION—Perform nursing procedures, assist physicians, and use equipment following established standards. EVALUATION—Evaluate the patient’s response to nursing interventions and physician ordered therapy / diagnostics. Update or modify plan of care to meet the current needs of the patient. PATIENT EDUCATION—Educate the patient and significant others based on the cognitive needs of each and defined by patient outcome goals. DOCUMENTATION—Document concise, accurate and timely information in the patient care record. PATIENT/FAMILY RIGHTS—Demonstrate knowledge of and respect for patient and significant others’ rights, including confidentiality. SAFETY/RISK MANAGEMENT—Follow established standards in provision for safety. LEGAL ISSUES—Demonstrate awareness of legal issues in all aspects of patient care and department function and strive to manage situations in a reduced risk manner. EMERGENCIES—Perform efficiently in emergency patient situations following established standards, remaining calm, informing appropriate persons, and documenting events. KNOWLEDGE BASE—Maintain a current knowledge base and use standards of care in professional practice. PROFESSIONALISM—Assume responsibility for own practice including appearance, attendance, punctuality and flexibility in scheduling. SELF EDUCATION—Pursue self-directed learning experiences, continuing education, and seek direction when necessary. STAFF DEVELOPMENT—Participate in and promote staff development activities and achievement of department goals. QUALITY ASSURANCE/STANDARDS DEVELOPMENT—Participate in peer review, quality assurance, standards development, and research activities. COORDINATION/ORGANIZATION—Use delegation skills and therapeutic use of self to coordinate and organize patient care delivery. COORDINATION/ORGANIZATION—Set priorities in work using effective time management and support personnel to complete assigned work. PROBLEM SOLVING/DECISION MAKING—Practice effective problem identification and resolution skills as a method of sound decision making. COMMUNICATION—Use written and oral communication through designated channels to attain desired patient outcomes as well as department and hospital goals. STAFFING—Demonstrate flexibility in staffing patterns and resolution of staffing conflicts; participate in temporary assignment measures. ORIENTATION-Successful completion of unit-specific core competencies as defined in the orientation checklist. DELEGATION--Evaluates and identifies patient needs and assigns appropriate staff to address specific individual patient needs. Directs and reviews the work of support staff to assure nursing care plan is fully implemented and patient needs are addressed. Assumes supervisory duty for department employees in absence of Clinical Director and Clinical Coordinator per HR-45 policy. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.
General Summary: The RN Staff Nurse is a professional care giver who assumes responsibility and accountability for a group of patients for a designated time frame and provides care to these patients via therapeutic use of self, the nursing process, the environment / instrumentation, and other health care team members. Assigns and directs the work of related staff. Requirements: Michigan Registered Professional Nurse licensure required. Bachelor of Science in Nursing preferred. Current Basic Life Support (BLS/CPR) provider—required. Previous experience in specialty preferred. Pediatric RN: Current Pediatric Advanced Life Support (PALS) provider-preferred. Must obtain PALS certification within one year of hire or placement in the unit. Endoscopy RN: Current Advanced Cardiac Life Support (ACLS) provider-preferred. Must obtain ACLS certification within 60 days of hire or placement in the unit. Level 4/Level 5 RN: Current Advanced Cardiac Life Support (ACLS) provider-preferred. Must obtain ACLS certification within one year of hire or placement in the unit. Level 4/Level 5 RN: Competence in basic cardiac dysrhythmia interpretation required, will train. Essential Functions and Responsibilities: ASSESSMENT—Assess the patient's condition and physical, psychological, cognitive, social, rehabilitative, and discharge needs. PLANNING—Develop a plan of care using nursing diagnoses and setting patient outcome goals. IMPLEMENTATION—Implement nursing plan of care and physician's orders. IMPLEMENTATION—Establish priorities of patient care based on essential patient needs and available resources of time, personnel, equipment and supplies. IMPLEMENTATION—Perform nursing procedures, assist physicians, and use equipment following established standards. EVALUATION—Evaluate the patient’s response to nursing interventions and physician ordered therapy / diagnostics. Update or modify plan of care to meet the current needs of the patient. PATIENT EDUCATION—Educate the patient and significant others based on the cognitive needs of each and defined by patient outcome goals. DOCUMENTATION—Document concise, accurate and timely information in the patient care record. PATIENT/FAMILY RIGHTS—Demonstrate knowledge of and respect for patient and significant others’ rights, including confidentiality. SAFETY/RISK MANAGEMENT—Follow established standards in provision for safety. LEGAL ISSUES—Demonstrate awareness of legal issues in all aspects of patient care and department function and strive to manage situations in a reduced risk manner. EMERGENCIES—Perform efficiently in emergency patient situations following established standards, remaining calm, informing appropriate persons, and documenting events. KNOWLEDGE BASE—Maintain a current knowledge base and use standards of care in professional practice. PROFESSIONALISM—Assume responsibility for own practice including appearance, attendance, punctuality and flexibility in scheduling. SELF EDUCATION—Pursue self-directed learning experiences, continuing education, and seek direction when necessary. STAFF DEVELOPMENT—Participate in and promote staff development activities and achievement of department goals. QUALITY ASSURANCE/STANDARDS DEVELOPMENT—Participate in peer review, quality assurance, standards development, and research activities. COORDINATION/ORGANIZATION—Use delegation skills and therapeutic use of self to coordinate and organize patient care delivery. COORDINATION/ORGANIZATION—Set priorities in work using effective time management and support personnel to complete assigned work. PROBLEM SOLVING/DECISION MAKING—Practice effective problem identification and resolution skills as a method of sound decision making. COMMUNICATION—Use written and oral communication through designated channels to attain desired patient outcomes as well as department and hospital goals. STAFFING—Demonstrate flexibility in staffing patterns and resolution of staffing conflicts; participate in temporary assignment measures. ORIENTATION-Successful completion of unit-specific core competencies as defined in the orientation check-list. DELEGATION--Evaluates and identifies patient needs and assigns appropriate staff to address specific individual patient needs. Directs and reviews the work of support staff to assure nursing care plan is fully implemented and patient needs are addressed. Assumes supervisory duty for department employees in absence of Clinical Director and Clinical Coordinator per HR-45 policy. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.
General Summary: The RN Staff Nurse is a professional care giver who assumes responsibility and accountability for a group of patients for a designated time frame and provides care to these patients via therapeutic use of self, the nursing process, the environment / instrumentation, and other health care team members. Assigns and directs the work of related staff. Requirements: Michigan Registered Professional Nurse licensure required. Bachelor of Science in Nursing preferred. Current Basic Life Support (BLS/CPR) provider—required. Previous experience in specialty preferred. Endoscopy RN: Current Advanced Cardiac Life Support (ACLS) provider preferred. Must obtain ACLS certification within 60 days of hire or placement in the unit. Level 4/Level 5 RN: Current Advanced Cardiac Life Support (ACLS) provider preferred. Must obtain ACLS certification within one year of hire or placement in the unit. Level 4/Level 5 RN: Competence in basic cardiac dysrhythmia interpretation required, will train. Level 6: Current Pediatric Advanced Life Support (PALS) provider preferred. ED: Current Pediatric Advanced Life Support (PALS) provider preferred. Must obtain PALS certification within six months of hire or placement in the unit. Advanced Cardiac Life Support (ACLS) certification within three (3) months after hire or transfer. Must maintain ACLS certification with re-certification every two (2) years. IR/NEURO IR RN: Current Advanced Cardiac Life Support (ACLS) provider required. HPE Infusion/Cancer Center Infusion RN: Must obtain ONS/ONCC Chemotherapy Immunotherapy Certificate prior to administering chemotherapy. Essential Functions and Responsibilities: ASSESSMENT—Assess the patient's condition and physical, psychological, cognitive, social, rehabilitative, and discharge needs. PLANNING—Develop a plan of care using nursing diagnoses and setting patient outcome goals. IMPLEMENTATION—Implement nursing plan of care and physician's orders. IMPLEMENTATION—Establish priorities of patient care based on essential patient needs and available resources of time, personnel, equipment and supplies. IMPLEMENTATION—Perform nursing procedures, assist physicians, and use equipment following established standards. EVALUATION—Evaluate the patient’s response to nursing interventions and physician ordered therapy / diagnostics. Update or modify plan of care to meet the current needs of the patient. PATIENT EDUCATION—Educate the patient and significant others based on the cognitive needs of each and defined by patient outcome goals. DOCUMENTATION—Document concise, accurate and timely information in the patient care record. PATIENT/FAMILY RIGHTS—Demonstrate knowledge of and respect for patient and significant others’ rights, including confidentiality. SAFETY/RISK MANAGEMENT—Follow established standards in provision for safety. LEGAL ISSUES—Demonstrate awareness of legal issues in all aspects of patient care and department function and strive to manage situations in a reduced risk manner. EMERGENCIES—Perform efficiently in emergency patient situations following established standards, remaining calm, informing appropriate persons, and documenting events. KNOWLEDGE BASE—Maintain a current knowledge base and use standards of care in professional practice. PROFESSIONALISM—Assume responsibility for own practice including appearance, attendance, punctuality and flexibility in scheduling. SELF EDUCATION—Pursue self-directed learning experiences, continuing education, and seek direction when necessary. STAFF DEVELOPMENT—Participate in and promote staff development activities and achievement of department goals. QUALITY ASSURANCE/STANDARDS DEVELOPMENT—Participate in peer review, quality assurance, standards development, and research activities. COORDINATION/ORGANIZATION—Use delegation skills and therapeutic use of self to coordinate and organize patient care delivery. COORDINATION/ORGANIZATION—Set priorities in work using effective time management and support personnel to complete assigned work. PROBLEM SOLVING/DECISION MAKING—Practice effective problem identification and resolution skills as a method of sound decision making. COMMUNICATION—Use written and oral communication through designated channels to attain desired patient outcomes as well as department and hospital goals. STAFFING—Demonstrate flexibility in staffing patterns and resolution of staffing conflicts; participate in temporary assignment measures. ORIENTATION-Successful completion of unit-specific core competencies as defined in the orientation checklist. DELEGATION--Evaluates and identifies patient needs and assigns appropriate staff to address specific individual patient needs. Directs and reviews the work of support staff to assure nursing care plan is fully implemented and patient needs are addressed. Assumes supervisory duty for department employees in absence of Clinical Director and Clinical Coordinator per HR-45 policy. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.
General Summary: The RN Staff Nurse is a professional care giver who assumes responsibility and accountability for a group of patients for a designated time frame and provides care to these patients via therapeutic use of self, the nursing process, the environment / instrumentation, and other health care team members. Assigns and directs the work of related staff. Requirements: Michigan Registered Professional Nurse licensure required. Bachelor of Science in Nursing preferred. Current Basic Life Support (BLS/CPR) provider—required. Previous experience in specialty preferred. Endoscopy RN: Current Advanced Cardiac Life Support (ACLS) provider preferred. Must obtain ACLS certification within 60 days of hire or placement in the unit. Level 4/Level 5 RN: Current Advanced Cardiac Life Support (ACLS) provider preferred. Must obtain ACLS certification within one year of hire or placement in the unit. Level 4/Level 5 RN: Competence in basic cardiac dysrhythmia interpretation required, will train. Level 6: Current Pediatric Advanced Life Support (PALS) provider preferred. ED: Current Pediatric Advanced Life Support (PALS) provider preferred. Must obtain PALS certification within six months of hire or placement in the unit. Advanced Cardiac Life Support (ACLS) certification within three (3) months after hire or transfer. Must maintain ACLS certification with re-certification every two (2) years. IR/NEURO IR RN: Current Advanced Cardiac Life Support (ACLS) provider required. HPE Infusion/Cancer Center Infusion RN: Must obtain ONS/ONCC Chemotherapy Immunotherapy Certificate prior to administering chemotherapy. Essential Functions and Responsibilities: ASSESSMENT—Assess the patient's condition and physical, psychological, cognitive, social, rehabilitative, and discharge needs. PLANNING—Develop a plan of care using nursing diagnoses and setting patient outcome goals. IMPLEMENTATION—Implement nursing plan of care and physician's orders. IMPLEMENTATION—Establish priorities of patient care based on essential patient needs and available resources of time, personnel, equipment and supplies. IMPLEMENTATION—Perform nursing procedures, assist physicians, and use equipment following established standards. EVALUATION—Evaluate the patient’s response to nursing interventions and physician ordered therapy / diagnostics. Update or modify plan of care to meet the current needs of the patient. PATIENT EDUCATION—Educate the patient and significant others based on the cognitive needs of each and defined by patient outcome goals. DOCUMENTATION—Document concise, accurate and timely information in the patient care record. PATIENT/FAMILY RIGHTS—Demonstrate knowledge of and respect for patient and significant others’ rights, including confidentiality. SAFETY/RISK MANAGEMENT—Follow established standards in provision for safety. LEGAL ISSUES—Demonstrate awareness of legal issues in all aspects of patient care and department function and strive to manage situations in a reduced risk manner. EMERGENCIES—Perform efficiently in emergency patient situations following established standards, remaining calm, informing appropriate persons, and documenting events. KNOWLEDGE BASE—Maintain a current knowledge base and use standards of care in professional practice. PROFESSIONALISM—Assume responsibility for own practice including appearance, attendance, punctuality and flexibility in scheduling. SELF EDUCATION—Pursue self-directed learning experiences, continuing education, and seek direction when necessary. STAFF DEVELOPMENT—Participate in and promote staff development activities and achievement of department goals. QUALITY ASSURANCE/STANDARDS DEVELOPMENT—Participate in peer review, quality assurance, standards development, and research activities. COORDINATION/ORGANIZATION—Use delegation skills and therapeutic use of self to coordinate and organize patient care delivery. COORDINATION/ORGANIZATION—Set priorities in work using effective time management and support personnel to complete assigned work. PROBLEM SOLVING/DECISION MAKING—Practice effective problem identification and resolution skills as a method of sound decision making. COMMUNICATION—Use written and oral communication through designated channels to attain desired patient outcomes as well as department and hospital goals. STAFFING—Demonstrate flexibility in staffing patterns and resolution of staffing conflicts; participate in temporary assignment measures. ORIENTATION-Successful completion of unit-specific core competencies as defined in the orientation checklist. DELEGATION--Evaluates and identifies patient needs and assigns appropriate staff to address specific individual patient needs. Directs and reviews the work of support staff to assure nursing care plan is fully implemented and patient needs are addressed. Assumes supervisory duty for department employees in absence of Clinical Director and Clinical Coordinator per HR-45 policy. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.
