Case Manager RN

Responsibilities:

• Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.
  Addresses/resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge.
  Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Department standards.
  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 to assure continuity of care.
  Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician.
  Documents relevant discharge planning information in the medical record according to Department standards.
  Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation.
  Refers appropriate cases for social work intervention based on Department criteria.
  Initiates and facilitates referrals for home health care, hospice, medical equipment and supplies.
  Collects delay and other data for specific performance and/or outcome indicators, including but not limited to Avoidable Days, as determined by Director/Manager.
  Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
  Communicates relevant clinical information, including admission review, concurrent review, and discharge planning needs, to third party payors to secure optimal reimbursement.
  The Case Manager will:
  Follow 100% of assigned inpatient admissions;
  Determine the medical appropriateness of the patient’s admission (severity of illness);
  Monitor the plan of care and proactively identify barriers to the plan (intensity of service);
  Intervene to avoid delays in plan of care;
  Identify trends in inappropriate utilization due to delays in diagnostic testing, medical and surgical procedures, and physician management;
  Coordinate flow of clinical information with third party payors to ensure appropriate reimbursement, proactively identify potential denials in order to avoid non-appealable denials;

Credentials:

• Registered Nurse - NJ (Required)
• Certified Case Manager (Required)
• National Case Management certification preferred; or obtained within two years of employment.

Education or Equivalent Experience:

• Bachelor of Arts or Science (Required)
• BSN degree required Minimum of 3 years Medical-Surgical experience required; Case Management and Discharge Planning experience preferred.