Nurse Case Manager

This position will coordinate with the multidisciplinary team and any other appropriate and accredited healthcare provider in the provision of quality patient care, under the guidance and supervision of the Senior Case Coordinator. The case coordinator will coordinate appropriate providers and access appropriate services to progress the patient’s episode of care in a timely manner.

Responsibilities

• Maintains active communication with physicians, nursing, and other appropriate members of the multidisciplinary team for the appropriate patient care management.
• Participates in regular communication and feedback with Senior Case Coordinator.
• Manages evidence-Based Medical Necessary screening criteria in support of admission and continued stay reviews and communicates with payers as necessary
• Determines Correct Level of care placement- utilization management
• Provides accurate medical documentation and health insurance documentation
• Facilitates resource utilization- ensuring the available funding meets the clinical needs
• Acts as a liaison between clinician and revenue department
• Identifies and resolves variances to clinical pathways and obstacles to discharge.
• Consults from appropriate disciplines/departments as required expediting care and facilitating discharge.
• Ensures patient care is rendered to the maximum stipulation based on the patient’s benefits under the Insurance contract without exceeding the providers’ provision for the cost of care
• Monitors and intervening as necessary to achieve desired goals and outcomes for both the patient and the hospital
• Assesses and intervenes to address psychosocial needs including patient, family and community and collaborates with social workers as appropriate
• Supports physicians in relation to Clinical Documentation impacting Medical Necessity, Case Mix Index, and Severity of Illness
• Monitors length of stay and resource use on an ongoing basis and discusses trends with Senior Case Manager
• Assists in the collection and reporting of indicators including LOS, excess days, resource utilization, and readmission rates.
• Acts as a patient advocate in facilitating education based on identified learning needs of the patient and/or those providing care and documents appropriately

Accountabilities:

Monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient-focused, quality efficient, and cost-effective.

Plans utilization of resources and ensures the available funding meets the clinical needs

Facilitates along the Continuum of Care, monitoring against Clinical Pathway, and facilitation of transition plans

Ensures proactive discharge planning

Qualifications

Educational Qualification:
Required:
Bachelor’s Degree in Nursing
Degree in Nursing (minimum two (2) years course duration) and Registration as a Registered Nurse from Canada, USA, UK, Ireland, South Africa, New Zealand, and Australia
Valid/Current national license.
BLS

Desired:
N.A.

Specialist Certifications:
Required:
Case Management Certification
Desired:
N.A.

Experience:
Required:
6 years’ experience in SSMC as staff nurse
OR
6 years of experience of which not less than 2 years in Case Management in a similar health care facility

Desired:
Experience in Large Healthcare facility