RN-Case Manager

RN-Case Manager in Meridian Mississippi United States

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RN-Case Manager Job ID: 39782 Job Category: Nurse RN Work Type: PRN Work Schedule: Rotating Department: Case Management Administration Facility: BMH Anderson Hospital Location: Meridian MS

Overview

Job Summary Case Managers will apply systems science incentives and information to improve healthcare practice and assist patients and their support systems to become engaged in a collaborative process designed to manage medical, social, mental health conditions more effectively. The case managers objective is to achieve an optimal level of wellness for patients and improve coordination of care while providing cost-effective, non-duplicative services. Performs all other duties as assigned.

Responsibilities

• Assess and document the clinical, psychosocial, and financial needs of patients, including availability of care support, risk for readmission, and safe environment upon discharge, transition, and payor benefits.
• Findings are collected by interviewing patients, caregivers, and members of the interdisciplinary team.
• Aspects of this assessment obtained from the patient record or previous case manager assessment are validated, updated, and influence the plan of care.
• Assess and document the patients care management and potential discharge needs.
• Apply InterQual to determine/validate Level of Service and Intensity of Care.
• Utilize InterQual criteria within the first 24 hours of arrival to complete an initial review.
• Collaborate with physicians, Manager of Case Management, and physician advisors to resolve conflicts.
• Coordinate with bed control to attain proper placement.
• Perform concurrent reviews of medical records to ensure continued appropriateness and make recommendations based on the needs of the patient.
• Escalate and facilitate resolution of unjustifiable aspects of care that vary from InterQual guidelines.
• With the physician, identify the plan of care, estimated length of stay, and discharge plan.
• Meet with patients and families to engage them in the plan and obtain agreement.
• Incorporate all processes and procedures into the plan to ensure safe discharge/transition.
• Coordinate with physician and nurse to make plan adjustments as patient condition indicates.
• Use best practices and available pathways to anticipate the course of care through discharge/transition.
• Incorporate ancillary services as needed.
• Work in collaboration with social work for complex post-acute placement and community service resources.
• In coordination with nursing, ancillary departments, social work, and the physician, monitor and ensure the treatment plan and steps to prepare for transition or discharge are completed as planned; gaps in care are avoided as well as duplicative or unnecessary services.
• Ensure that patients are discharged/transitioned timely and appropriately and that variances from the plan or target discharge/transition date are documented.
• Escalate concerns and barriers to appropriate treatment or transition as outlined by the department.
• Maintain a working knowledge of facilities and resources available to patients and caregivers.

Specifications

Experience

• Minimum Required: 3 years Healthcare/Medical-Acute Care.
• Preferred/Desired: Healthcare/Medical-Case Manager or Healthcare/Medical - Utilization Review.

Education

• Minimum Required: Graduate of School of Nursing (Accredited).
• Preferred/Desired: Bachelors Degree Nursing or Bachelors Degree Allied Health.

Training

• Minimum Required: None specified.
• Preferred/Desired: None specified.

Special Skills

• Must be able to work with acutely & chronically ill patients of all ages and their caregivers.
• Must have excellent interpersonal communication, multi-tasking, prioritizing & organizational skills.
• Demonstrated ability to work effectively with teams in a collaborative manner and escalate issues appropriately.
• Ability to work weekends and flexible hours per the department staffing plan.

Licensure

• Minimum Required: License/Certification/Registries valid for the State of MS Registered Nurse (RN) by the State Board of Nursing.
• Preferred/Desired: Certification by the Case Management Society of America or Equivalent Certification.

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