Overview
The Case Manager performs a variety of integrated functions while applying broad professional nursing knowledge. Analyzes and evaluates medical information for quality and appropriateness of care; screens records with variations for peer review; responsible for appropriate and timely intervention and coordination with other members of the Care Management Team to resolve problems related to quality/utilization management activities; provides pertinent clinical data to outside agencies as needed to assure compliance with their requirements; acts as a resource for hospital and medical staff regarding clinical documentation requirements; evaluates patient outcomes through clinical path monitoring.
Responsibilities
- (25%) Documents appropriate to patient\'s needs and documentation requirements.
- (25%) Collaborates with staff, patients, and families in coordinating the referral of patients to appropriate community agencies as determined by their individual discharge plan.
- (25%) Initiates timely discharge planning screening on all admissions, and assesses further as needed.
- (25%) Develops a discharge plan based on needs identified from assessment.
Other duties and responsibilities
- Operates department within volume adjusted budget.
- Demonstrates ability to communicate effectively with the medical staff to achieve desired outcomes.
- Promotes opportunities for staff education in:
- New employee orientation
- Department/job specific education
- Education for new services provided by the department.
- Sets yearly departmental and personnel goals.
- Assist in education of staff on Case Management policies, procedures, and community resources.
- Assumes responsibility for continuing education/professional development related to area of practice; including job specific professional journals.
- Maintains effective quality management and/or improvement program to measure assess and prove services of the department.
- Markets MyMichigan Medical Center- Gratiot and their subsidiaries, using their services when appropriate to patient/needs/desires.
- Maintain relationships with community agencies to keep current with available resources.
- Facilitates multidisciplinary team meetings as scheduled.
- Implements discharge plan and monitors need for changes in plan to avoid delays in discharge in collaboration with other team members.
- Provides direction with implementation of care pathways.
- Responsible for concurrent review of charts to ensure compliance with core measures and other quality measures as determined.
- As a member of the Utilization Management team, strives to develop and assist with effective utilization management processes.
- Demonstrates competency in Infection Prevention and Control Practices and Policies.
- RM CM may be responsible for Utilization Review and Discharge Planning simultaneously or separately based on department and health system needs. Additional cross training will be available when required and requested.
- Other Duties as assigned.
Certifications and Licensures
- Credential: RN: Registered Nurse
- Equivalent Experience:
- Qualification Source:
- Essential: true
Required Education
- Education: Associates Degree
- Equivalent Experience: Three to five years of recent clinical experience in the acute care setting is required. Knowledge of data analysis and bachelor\'s of Science preferred or a commitment to pursue such degree is preferred.
- Education Specialization: NRG
- Essential: true
Other Information
- EXPERIENCE, TRAINING AND SKILLS:
- Three to five years of recent clinical experience in the acute care setting.
- Must be proficient with computer skills and applications.
- Interpersonal skills needed to communicate successfully with individuals and groups and interact with people at all levels to communicate ideas and concepts in a clear and understandable manner.
- Mandatory tuberculosis (TB) testing must be done as required.
- Mandatory Occupational Safety and Health Administration (OSHA) training must also be completed annually according to the Exposure Control Plan.
PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS
- Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death.
- Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.
- Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description.
- Overall vision and hearing is necessary with or without assisted device(s).
- Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching.
- Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required.
- Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake.
- Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis.
- Physical Demand Level: Sedentary. Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.
Other Comments
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