The care manager coordinates the care and service of selected patient populations across the continuum. He/she works collaboratively with physicians and other members of the health care team to achieve the highest quality clinical outcomes with the most cost effective use of available resources. The care manager assumes responsibility for an interdisciplinary process which assesses plans, implements, monitors and measures the effectiveness of interventions to meet patients’ treatment and transitional needs. The care manager provides services to neonate, pediatric, adolescent, adult and geriatric patients and demonstrates the knowledge and skills necessary to offer care appropriate to the age of the patient.
A. Provides the professional clinical component of the Acute Care Management model to ensure that department services support quality patient care and safety while coordinating patient throughput.
a. Prioritizes patient needs for Care Management services based on: target/high volume Diagnosis-Related Group (DRG), high cost, outlier, LOS, frequent inpatient admission, unplanned readmission or significant variance.
b. Supports the healthcare team with identifying decisions maker to ensure all plans and expectations are communicated in a timely manner including discharge plans and expected LOS outcomes and documents appropriately in the patient’s electronic health record.
c. Identifies risk factors for potential crisis intervention needs related to clinical diagnosis, prognosis and/or patient/family dynamics.
d. Coordinates the discharge planning process. Acts as a resource for discharge planning. Collaborates with the healthcare team to develop a discharge plan that includes the next step in the continuum (Post-acute services including Home Care, Durable Medical Equipment, Nursing Home Placement and/or other services) to identify patient needs relating to medical diagnosis, treatment, financial resources and psychosocial needs, assisting in transitioning patients to the appropriate Level of Care (LOC).
e. Ensures the multidisciplinary discharge plan is consistent with the patient’s clinical course, continuing care needs and covered services. Evaluates on an ongoing basis the patient’s status and progress toward reaching goals set forth in the plan of care. Revises and updates treatment plans as necessary and provides supportive documentation.
f. Documents assessments, discharge plans and changes to discharge plans in the patient’s electronic health record.
g. Participates in Touch Base Rounds in assigned areas and physician rounding on select patients.
h. Works collaboratively with healthcare team on appropriate documentation to accurately reflect the severity of patient’s illness. Actively participates in the education of physicians and other healthcare team members on appropriate utilization of services and Level of Care (LOC) indicated by the clinical and/or socio economic situation to achieve optimal reimbursement.
i. Conducts referrals to Care Management Leadership, Vice President of Medical Affairs, Ethics Committee, Risk Manager, and Legal Services as appropriate.
j. Reviews daily admission and collaboratively creates a plan to positively impact desired outcomes.
Education: Registered Nurse with Bachelors degree or diploma/associates degree with care management certification within 2 years of hire date (CCM or ACM)
Licensure: A current unencumbered RN license to practice in the State of Arkansas is required.
Preferred: Masters degree & case management certification (CCM or ACM)
Experience: Requires Minimum of three years in acute care hospital
Preferred – experience in case management, discharge planning or utilization management role
Recommended skills: Familiarity with case management role in health care setting
Knowledge of medical terminology, utilization management criteria, community resources, and health care reimbursement systems
Ability to analyze data, apply critical thinking process to problem-solving
Demonstrated capacity to work with inter- disciplinary team (especially physicians) and communicate effectively
Physical Requirements: Occasionally requires light physical effort as in periods of standing at files or
worktables, repeated changes of position within the work routine or prolonged sitting. Regular volume of work and deadlines impose strain on routine basis. Nature of work requires substantive involvement in stressful situations causing strain. Frequent exposure to occupational hazards or contagious disease which requires routine precautions.
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