Healthcare - Health Services
2 Year Degree
At least 2 year(s)
The Case Manager strives for excellence in patient care by assisting the patient and their families navigate the complex health care delivery system. Facilitates and coordinates services through the building of collaborative relationships among the nursing staff as well as other care disciplines. Asists the patient with their journey through the care continuum by ongoing assessment, planning and evaluation. This assessment includes admission status, on going medical necessity assessment, planning of care, delivery and utilization of services as well as monitoring quality. Ongoing goals include the fluid transition of the patient to the next level of care. This is done in collaboration with the healthcare team, the patient and the patient’s family. Supports an environment of healing and wellness through collaboration which focuses on excellence in patient care delivery, quality and documentation. The Care Manager is an exemplar for compassion, acceptance, respect and empathy. Recognizes and honors nursing as a distinct discipline and support an environment focused on healing and wellness.
Collaborates with the patient, family, physician and other health care professionals to perform initial and concurrent patient assessment and referrals / recommendations
Uses severity of illness/intensity of services indexes to determine appropriateness of admissions, transfers and continued stays;
Advocates for adherence to best practice standards through use of approved guidelines, protocols and order sheets;
Provides physicians and ancillary departments with data on treatment outcomes and avoidable delays in order to promote highest quality care;
Works in conjunction with Payer Specialists in communicating and negotiating with commercial payers or other outside agencies in order to obtain needed services for patients and accurate reimbursement for the hospital
Takes a leadership role in identifying opportunities to reduce risks, both financial and clinical, through analysis of resource consumption outcomes
II. Transitional Planning
- Works with interdisciplinary team to coordinate needed services to ensure efficient continuity of care.
- Assesses need for services through collaboration via Bedside Rounding on patients as well as with physicians and other interdisciplinary team members
- Plans for care needs with active involvement of patient, significant others, hospital staff involved in treatment process;
- Oversees implementation of transition plans with support from internal and external agents;
- Monitors patients' progress and adequacy of planning process through regular communication with patients and service providers;
- Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/agencies adhering to legal mandates about confidentiality;
- Measures effectiveness of interventions through direct communication with patients and caregivers and data collection of defined indicators (e.g., overall length of stay, readmission rates, feedback from referral sources, etc.).
- Identifies problems or gaps in community resources that impact outcomes and takes leadership role in efforts to effect changes.
III. Advocacy for Quality Outcomes
- Acts as a patient advocate for optimum care and a business partner to the physician.
- Participates as a team member to facilitate communication among all disciplines, identify barriers to meeting treatment goals, and determine ways to achieve best outcomes; as evidenced by facilitating and actively participating in Bedside Rounding
- Provides information and support to patients and families, helping them access needed resources within the medical center and community;
- Assists physicians in obtaining needed services for their patients and having access to all available data on best practice and financial outcomes;
- Cultivates collegial partnerships with physicians and other health care professionals and maintains high customer satisfaction ratings in dealing with patients and their significant others;
- Demonstrates innovative problem-solving skills and ability to analyze and organize data to provide evidence for necessary process changes.
IV. Professional Development
- Takes responsibility for adhering to case management standards of practice, hospital and departmental policies and procedures, and for professional development.
- Performs all assigned tasks according to standards defined by the Case Management Society of America and other relevant professional groups;
- Promotes a safe and effective work environment by following institutional guidelines for work activities, reporting any variances to department director immediately.
- Participates actively in relevant educational programs and shares information with other members of department and health care team;
- Maintains knowledge base about relevant clinical and fiscal issues and about community resources.
- Participates actively in staff meetings, designated hospital committees and community groups/task forces.
- Takes an active role in appraisal process, documenting achievements and defining goals for self and department annually.
- Collaborates with other case managers to ensure effective and efficient operations, using effective communication skills to share information and constructive feedback.
Associates Degree in Nursing required, BSN preferred.
CCM experience with Interqual/M & R or Discharge Planning preferred. Prefer 2 years recent varied acute hospital experinece. 3-5 years recent varied acute hospital experience, 1 year Case Management or home health working with Medicare/Medicaid and other federal guidelines or 2 years Case Management in hospital setting and experience in discharge planning with Case Management Model. Strong clinical background with a broad range of clinical experience and the ability to utilize data and regulatory information in decision making process. Level of care criteria (i.e. interqual ISD-AmM&R), Pro Criteria and quality screens. Knowledge of QA processes. Experience with screening for quality of care issues and clinical criteria.
Current state Nursing licensure.
Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times. Adheres to and exhibits our core values:Reverence:
Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.Integrity:
Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.Compassion:
Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.Excellence:
Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality. Maintains confidentiality and protects sensitive data at all times. Adheres to organizational and department specific safety standards and guidelines. Works collaboratively and supports efforts of team members. Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.
KentuckyOne Health and its organizations are Equal Opportunity Employers
Scheduled Hours per 2-week Pay Period: 80
Weekends Required: Occasional
Status: Full Time