SECTION I

BASIC FUNCTION:

The RN Case Manager has responsibility for case management of assigned patients on a designated unit(s). This position works with the physicians and interdisciplinary team to facilitate and maintain compassionate, efficient quality care and achievement of desired treatment outcomes. The Case Manager confirms admission and continued stay are medically necessary and ensures the interdisciplinary care plan and the discharge plan are consistent with the patient’s required needs and covered services. Support services provided by the Case Manager include, but are not limited to, utilization review, case management, care transition, collaboration with physicians and social workers for care coordination and discharge planning.

SECTION II

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Current license or valid permit to practice professional nursing in the state of New York

• Associate’s degree in nursing required, Bachelor's degree in nursing strongly preferred

• Two years of inpatient experience in a hospital environment preferred.

• Previous case management, utilization review, and discharge planning experience highly preferred. Home care, payer, or other experience will be considered.

  SECTION III

  PHYSICAL REQUIREMENTS:

  The position is located indoors and has community responsibilities in which the incumbent is required to attend. Should be able to push/pull 35 lb., lift/move 15 lb. from floor to table, be able to perform moderately difficult manual manipulations such as using a keyboard, writing and filing for extended periods of time, must be able to perform tasks which require hand-eye coordination such as data entry, typing and using photo copiers. Mobility requirements may include the ability to sit at a computer terminal or work station for a prolonged period of time in addition to being able to squat, stand and walk for a reasonable length of time and distance and manual dexterity. Sensory requirements include the ability to articulate and comprehend the spoken English language in addition to being able to read the English language.

  SECTION IV:

  MAKING ELLIS EXCEPTIONAL (MEE) BEHAVIORS & STANDARDS

  SECTION V:

  RESPONSIBILITIES OF THE POSITION:

• Discharge Planning:

• Meets with patient and/or family/personal representative as soon as possible, to assess, evaluate, and identify discharge needs

• Screens patient for post-hospital needs throughout the continuum and makes appropriate referral for those identified; as well as, the high risk population, chronic medical problems, non-compliance issues, interdisciplinary and/or patient, family, requests

• Participates in interdisciplinary rounds, identifies anticipated discharge date and discharge plan and promptly escalates barriers to leadership

• Acts as a role model, maintains professional standards and collaborates with patients, families, caregivers, interdisciplinary team members, external agencies, insurance companies as needed to effectively execute discharge planning services, such as but not limited to: coordinating/leading team/family meetings, timely completion of NYS Peer Review Instrument and Screen, skilled nursing facility referrals and meetings, durable medical equipment referrals, ensuring completion of ambulance forms, discharge checklist and/or med-eval, etc…

• Develops a comprehensive discharge plan and oversight of the assigned unit

• Ensures that discharge planning plays a key role in the internal efficiency of the hospital by timely intervention for a low Length of Stay via identification of patient status – inpatient vs. outpatient/observation, resolving barriers to discharge, identifies and verifies payment source for services and equipment prior to implementation of discharge plan

• Collaborates and makes referrals to physician advisor when unable to resolve issues with attending physician

• Documents thoroughly and accurately in medical record

• Collaborates with physician and other members of the interdisciplinary team to develop, plan, and facilitate a safe and realistic discharge plan, re-evaluating every 3 days or adjusting as patient’s condition changes throughout patient’s hospitalization

• Documents thoroughly and accurately in medical record

• Identifies patients with complex discharge planning needs and complex psychosocial needs and coordinate transition of care with Social Worker

• Serves as nurse consultant for Social Worker cases with Clinical or discharge planning needs

• Coordinates acute hospital to hospital transfers to ensure compliance with all the discharge planning regulations and transfer policy

• Provides guidance, support, and back-up to social workers on patients in need of transfer, medical review and care planning

• Coordinates, plans, and participates in interdisciplinary discharge planning meetings, identifying barriers to discharge with participation of all disciplines

• Assures completion of discharge forms, i.e. Important Message from Medicare, PRI, and transportation within established timeframes and according to state/federal regulations

• Adheres to the New York State Department of Health and Centers for Medicare and Medicaid Services discharge planning guidelines and departmental/organizational policies and processes

• Utilization Management:

• Ensures order in chart/EMR coincides with the InterQual review or CMS rules and regulations for appropriate Level of Care and status on all patients through collaboration with Utilization Review RN

• Contacts the attending physician for additional information if the patient does not meet the appropriate InterQual guidelines or in accordance with CMS rules and regulations for continued stay

• Assesses and evaluates the medical necessity and appropriateness of ancillary testing, medications, treatment, and plan of care, discussing concerns with the involved physician, nurse or ancillary staff member. Make appropriate referral to physician advisor regarding trends/areas of concern

• Proactively monitors patient activity, identifying and resolving delay and barriers to discharge. Monitors length of stay, readmissions, and documents avoidable days for trending and performance improvement purpose

• Other

• Attends necessary in-services; seeks learning experiences and gathers medical/community knowledge as needed.

• Perform other duties as assigned and as listed in department Roles and Responsibility Grids

  Salary Range: Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.