Rn-Case Manager I Ed - Children's Hospital - Ft - 11Am-11Pm

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Human Resources
Important Applications Instructions:
Please complete this application in entirety by providing all of your work experience, education and certifications/
license. You will be unable to edit/add/change your application once it is submitted.
Job Requisition ID:
R00009939
Job Category:
Nursing
Organization:
Utilization Review
Location/s:
Main Campus Jackson
Job Title:
RN-Case Manager I ED - Children's Hospital - FT - 11am-11pm
Job Summary:
Under the general direction of the manager of case management, the ED case Manager Is responsible for initiating the provision of an organized patient focused system that coordinates the delivery of quality healthcare services across a continuum of care beginning in the ED by continually monitoring, evaluating, and modifying the treatment plan to achieve optimal patient outcomes. This system emphasizes patient and customer satisfaction and balances individually identified patient and family needs with the efficacious use of resources.
Education & Experience
Required: Associates degree in Nursing and four (4) years RN experience. Preferred: Utilization management, previous case management experience, Accredited Case Manager Certification (ACM) or Certified Case Manager (CCM).
Certifications, Licenses or Registration Required: Valid RN license.
Knowledge, Skills & Abilities
Excellent interpersonal communication and negotiation skills. Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. Understanding of pre-acute and post-acute venues of care and post-acute community resources. Ability to work independently and exercise sound judgement in interactions with physicians, payors, and patients and their families. Demonstrates commitment to the organizations mission and the behavioral expectations in all interactions and in performing all job duties. Performs duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety, cost efficiency, and commitment to continuous quality improvement (CQI) process.
Responsibilities

• Using criteria, conducts admission review/status screening for medical necessity and level of care needs for all potential admissions to the facility; inpatient or observation. Assesses the appropriateness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues and documentation sufficient to substantiate medical necessity. Uses quality screens to identify potential issues and forwards information to clinical quality review department.
• Assess, develop, and implement the ED patient's discharge planning needs - involving patient, physician, family, and other members of the health care team to ensure a safe and timely discharge from the ED. Communicates patient needs to appropriate professionals, i.e. social worker, clinical pharmacist, diabetes educator, dietitian etc, and provides follows up communication. Discusses payor criteria and issues on case-by-case basis with clinical staff and follows up to resolve problems with payors as needed, communicates with patients and families to ensure understanding of 3rd party payer guidelines and patient responsibility.
• Manages all aspects of discharge planning for assigned patients. Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician. Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation. Ensures / maintains plan consensus from patient/ family, physician and payor. Makes appropriate referrals for home health care, home medical equipment, acute rehab, or extended care facility placement (if possible from the ED), coordinating transfers to other facilities/agencies. Seeks out information and resources and uses creative problem solving for discharge planning, quality of care and utilization issues. Explores new resources when the opportunities for the patient are absent or in short supply.
• Refers appropriate cases for social work intervention based on department criteria. Act as a patient advocate in by providing patients/families with special needs with appropriate resources and referral. Assist homeless patients with information on shelters, emergency food lockers, emergency clothing resources and other services available for the population.
• Collects delay and other data for specific performance and /or outcome indicators as determined by administrator - resource management. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g. emergency department flows and care). Uses pathway data in collaboration with other disciplines to ensure effective patient management. Leads the development, implementation, evaluation and revision of clinical pathways and other case management tools as a member of the clinical resource team.
• Acts as preceptor/ mentor to new hires. Assists in development of orientation schedule and helps identify individual needs for learning.
• Ensures safe care to patients adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice. Promotes individual professional growth and development by meeting requirements for mandatory/ continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
• The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands
Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, occasional handling or working with potentially dangerous equipment, occasional exposure to biohazardous conditions such as risk of radiation exposure, blood borne pathogens, fumes or airborne particles, and/or toxic or caustic chemicals which mandate attention to safety considerations, occasional working hours significantly beyond regularly scheduled hours, occasional travelling to offsite locations, occasional activities subject to significant volume changes of a seasonal/clinical nature, occasional work produced subject to precise measures of quantity and quality, occasional bending, frequent lifting and carrying up to 25 pounds, occasional crouching/stooping, occasional kneeling, occasional pushing/pulling, occasional reaching, frequent sitting, frequent standing, occasional twisting, and frequent walking. (occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)
Time Type:
Full time
FLSA Designation/Job Exempt:
Yes
Pay Class:
Salary
FTE %:
100
Work Shift:
Evening
Benefits Eligibility:
Benefits Eligible
Job Posting Date:
12/1/2023
Job Closing Date (open until filled if no date specified):