ED/MH Nurse Case Manager

Navajo Preference Employment Act

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act.  Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference.
Overview

POSITION SUMMARY

The Nurse Case Manager, Emergency Department (ED) is responsible for establishing, coordinating, and maintaining the process to increase patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the ED. The Nurse Case Manager collaborates with the patient/family, multidisciplinary team, physicians, community resources and payers to ensure the patient’s progress and level of care is appropriately determined for the emergency episode of care and for the inpatient encounter to ensure that care is performed and facilitated in an efficient and cost-effective manner.

The Nurse Case Manager has well developed knowledge and skills in patient status determination (i.e. InterQual Criteria), in the assessment and care management of patients and families within the ED, inpatient and outpatient settings. The scope of practice includes patient/family assessment and management, resource management, identifying patients appropriate for Inpatient Admission, Observation, or Outpatient status, care facilitation, discharge planning with referral to all levels of care, and other related duties specific to the defined patient population. This Nurse Case Manager collaborates with other case managers, social work staff, the Access Center, Admissions, the Outcome Manager, and other physician and administrative leadership staff within the ED, the Coordinated Care Department and both the inpatient and outpatient settings. She/he uses knowledge of pathophysiology, pharmacology, and clinical care processes to participate with other clinical staff and physicians in the development of clinical practice guidelines and physician order sets for the purpose of improving quality of care, changing practice, and reducing costs. The role has a primary reporting relationship to the Director of Coordinated Care.

The ED/MH Nurse Case Manager works with an interdisciplinary team to assess care plans, monitor progress, and make recommendations to ensure safe and efficient hospitalizations. Responsible for evaluating patients in the ED for medical necessity and care coordination needs. Assesses potential admissions and works with advanced practice clinicians/physicians to determine appropriate admission status. Proposes and implements outpatient plans for safe discharge from the ED with physician approval. Coordinates care for patients with abuse, chronic pain, and frequent utilization issues. Interacts with patients or customers of all ages, from newborn to geriatric.

As part of this role, they will also interact with individuals who have mental health issues to help them access and navigate the resources they need to improve their well-being. with individuals who have mental health issues to help them access and navigate the resources they need to improve their well-being.

Qualifications

NECESSARY QUALIFICATIONS

Education:

       MSW Social Worker:

       Master’s Degree in Social Work (MSW)

RN Case Manager:

Associate’s degree in nursing

License/Certification:

MSW Social Worker:

• Licensed Master Social Worker (LMSW) 

       RN Case Manager:

• A valid, current, full and unrestricted Professional Nursing License to practice nursing in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United States
• Must have and maintain current Basic Life Support (BLS) certification by the American Heart Association throughout employment

Experience:

• Minimum of (2) two years of current care/case management experience in the Emergency Department
• Two (2) years of patient care experience (Hospital, Home health, Skilled Nursing)
• Proficient with Electronic Medical Records, Outlook, Microsoft Office Word, and Excel.
• Experience and knowledge of discharge planning, case management, or utilization review processes.

Other Skills and Abilities:

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers.  All employment references must address and indicate success in each one of the following areas:

• Positive working relationships with others
• Possession of high ethical standards and no history of complaints
• Reliable and dependable; reports to work as scheduled without excessive absences
• Effective verbal & written communication skills
• Team management focus promoting a positive and pro-active approach to problem resolution
• Completion of satisfactory and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job 
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading or incomplete information, as determined by TCRHCC.

MENTAL AND PHYSICAL EFFORT

The physical and mental demands described here are representative of those that must be met by an   employee to successfully perform the essential functions of this job.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical:

This position requires an individual of high energy who can maintain a long and flexible schedule to meet the management requirements. The physical requirements include sitting at a desk for long periods of time, long periods of sitting in meetings; frequent sitting for intense work on a personal computer, frequent walking to interact with staff within the facility, frequent bending, kneeling, crouching, twisting, maintaining balance and reaching. Must be able to hear, speak and comprehend over the telephone and in person with others. Must have ability to lift, push and pull up to 50lbs frequently. Sensory requirements for position include prolonged ability for far, near, and color vision, depth perception, seeing fine details, hearing normal speech, telephone use and ability to frequently hear overhead pages. Must have ability of both hand manipulation in simple and firm grasping, fine manipulation, and use of keyboard.

Mental:

Uses independent judgment and analytical skills to make decisions that impact operations, finances, and customer service within the organization.  The incumbent must have the ability to perform in structured and unstructured environments and possess a keen attention to detail and propose practices/mechanisms to enhance customer satisfaction. Must have ability to continually concentrate, handle a high degree of flexibility, handle multiple priorities in stressful situation, demonstrate high degree of patience, adapt to shift work, work in areas that are close in crowded, frequently cope with high levels of stress, make decisions under high pressure, work alone, and occasionally cope with anger/fear/hostility of others in a calm way and manage altercations.

Environmental:

May frequently be exposed to chemical agents, extremes in temperature of humidity, occasional exposure to infectious diseases, dust, fumes, gases, hazardous or moving equipment, and loud noises.

Responsibilities

ESSENTIAL FUNCTIONS

1. Coordination of service specific assessments, service planning and enrollment
2. Works with all facets of the Case Management continuum (i.e., social support, alternate resources, community referrals, discharge planning, Nursing Home/Skilled Nursing Placement and resource utilization).
3. Comprehensive and client centered service planning and coordination
4. Displays proven ability to positively influence behavior and outcomes. Demonstrates ability to work autonomously and be directly accountable for results.
5. Demonstrates proficiency in clinical case management, conducting comprehensive assessments, and utilizing effective critical thinking skills both in writing and verbally.
6. Exhibits age-appropriate interpersonal interactions with patients ranging from newborns to geriatric adults.
7. Works proactively with Nurse Case Managers of TCRHCC as a team member for care coordination of the patient populations.
8. Resource acquisition facilitated referrals and linkages.
9. Consistent and on-going case consultation with all direct service providers
10. Developing and maintaining internal and external resource relationships
11. Service monitoring and following up to ensure continuity of care and updating the client service plan
12. Identifies patient through consultation and high-risk diagnoses (i.e., COPD, CHF, DM)
13. Perform UR coordination functions by ensuring medical necessity of preadmission, admission, continued stay, cost containment and discharge planning on patients admitted TCRHCC as part of the ED Throughput.
14. Accountable for the education, knowledge and process related to the Recovery Audit Contractors role in inpatient and outpatient reimbursement as related to the impact on TCRHCC revenue.
15. Reviews TCRHCC inpatient admissions for medical necessity and is the lead for UR Committee reviews in collaboration with the Medical Staff representative.
16. Assists with the development of department reports, policy/procedures manuals, and program objectives
17. Assists with special projects as assigned
18. Conducts system and procedural efficiency evaluation to determine progress, performance, and conformity with program requirements
19. Assist in managing outpatient referrals for Purchased Referred Care (PRC)
20. Follow up outside inpatient referrals for continued follow up (i.e., appointments and PHN referrals)
21. Will provide coverage for the inpatient units-ACU, PEDS, ICU, OB, and ER to include Outpatient Clinics. Manages care of prioritized TCRHCC/SPHC outpatient/inpatient based upon consultation from providers within the TCRHCC/SPHC healthcare delivery system; provides a consistent and on-going consultation with service providers.
22. Works proactively and collaboratively with Public Health Nursing (PHN), Patient Benefit Coordinators (PBC), Utilization Review (UR) and Purchased Referred Care (PRC) at TCRHCC/SPHC.
23. Facilitate communication and coordination between members of the health care team, involving the client in the decision-making process in order to minimize fragmentation in the services (CMSA, 2010).
24. Develops with the patient/family and multidisciplinary team (including service area and/or other non-TCRHCC/SPHC providers as appropriate) a care and service delivery plan based upon the needs identified and available provider and financial resources of the patient and provides consistent and on-going case consultation with all direct service providers.
25. Provides service monitors and follow-up to ensure continuity of care, and updates of the client service plan and provides follow-up if needed. Striving to promote client self-advocacy and self-determination (CMSA, 2010).
26. Prepares patient and family for discharge from case management when services are no longer required. Arranges for any ongoing support/direct care services that the patient will need post-discharge in coordination with discharge planners and other entities such as PHN, Community Health Representatives or Tribal Social Services.
27. Will be familiar with Advance Directives and be a resource person for patients and families; facilitate informed choice, consent, and decision-making.
28. Promote use of evidence-based care, as available, in conjunction with the MCG Care Guidelines.
29. Pursue professional excellence and maintain competence in practice.
30. Serves as the outpatient/inpatient coordinator, such as:

• The primary contact for outpatient/inpatient in obtaining beds for admissions both within and outside of TCRHCC/SPHC.
• Collaborates with provider and nursing personnel to ensure admissions are conducted seamlessly and without delay of patient care.
• Collaborates with provider, nursing personnel and patient benefits coordinators that all admission documentation is complete and all referrals for third party resources are complete prior to the departure of patients.

      31. Will be committed to Case Management Services

      32.Will share in coverage all units, inpatient and outpatient for staffing shortages.

      33.Ensure proper PPE is worn at all times while on duty including but not limited to, face mask, gloves, gown, isolation gown,              NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield.

      34.Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC                     website for most current process)

      35.Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a                             communicable disease to ensure a high level of patient, visitor, employee and external customer satisfaction.

     36.Performs other duties as assigned.