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Schedule: 8am to 4:30pm with one weekend every four weeks
Shift Differential: $2.50/hr evenings, $2.00/hr weekends
Role Summary:
- Performs a comprehensive assessment of psychosocial and medical needs of assigned patients
- Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the medical record; plan is communicated to appropriate clinical disciplines
- Assumes a leadership role with the interdisciplinary team to manage care, through criteria driven processes, for the appropriate level of care, patient status and resource utilization
- Conducts interdisciplinary team meetings to provide a mechanism for all clinical disciplines to collaborate, plan, implement, and assess the plan of car; patient selection should be criteria based and interventions will be documented
- Evaluates admissions for medical necessity using approved criteria at defined intervals throughout the episode of care; escalates medical necessity and admission status issues through the established chain of command
- Evaluates and assess observation patients for appropriateness in observation status
- Performs utilization management reviews and communicates information to third party payors
- Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies
- Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services
- Makes appropriate referrals to third party payer disease and case management programs for recurring patients and patients with chronic disease states
- Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team
- Facilitates patient throughput with an ongoing focus on quality and efficiency
- Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems
- Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals
- Assesses patients’ post discharge needs and facilitates the provision of services necessary to meet identified needs
- Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered
- Identifies patients with the potential for high risk complications and makes appropriate referrals acting as an advocate for the individual’s healthcare needs
- Directs activities to identify and provide for the needs of the under resourced patient population to include patient education activities, patient assistance programs, and community based resources
- Develops individual plans of care for recurring patients to include education on appropriately accessing healthcare resources, preventative education, and community based resources
- Assumes a leadership role in the development, revision, and implementation of clinical protocols which transition patients across the continuum of care or discharge patients to an appropriate service level of care
- Tracks and trends variances to care and barriers to care; makes recommendations and develops action plans to improve processes and systems
- Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely
- Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered.
- Demonstrates knowledge of the occurrence reporting system. Uses system to report potential patient safety issues.
- Follows established guidelines for reporting a significant medical error or unanticipated outcome in the patient’s care which results in patient harm.
- Attends in-service presentations and completes all mandatory education requirements.
- Uses Performance Improvement Plan to improve patient safety.
- Regular, Punctual and dependable attendance.
- Other duties as assigned
Qualifications:
- Candidates are required to have a minimum of 3 years of RECENT (Within the last year) Case Manager experience in an acute care setting. The HM is also open to candidates with 3 years of experience on the following units: Med/Surg, Tele, Neuro, ICU, PCU, or ED. *will also consider candidates with Case manager experience in home health or insurance. For home health and insurance, they must have 3 years of acute care experience total and must have at least 1 year of acute care experience within the last 5 years.
- Associates Degree in Nursing or Diploma in Nursing required
- Bachelor’s Degree in Nursing preferred
- Current FL RN license required or appropriate compact licensure. If compact license held, active FL RN licenserequiredwithin90 days of hire
- Advanced Practice Registered Nurse license is acceptable for position if current and compliant
- Certification in Case Management, Nursing, or Utilization Review, preferred