Primary Location:

Mary and Elizabeth - UMC

Address:

1850 Bluegrass Ave Louisville, KY 40215

Shift:

Salary Shift (United States of America)

Job Description Summary:

The RN: Case Manager promotes optimal health care outcomes in accordance with the policies, procedures, applicable laws and contracts, philosophy, mission, vision and values of UofL Health; assumes responsibility and accountability for the appropriate utilization of facilities and services; serves as a resource to physicians, nurses and ancillary staff; conducts initial admission assessments; identifies patients who do not meet criteria and takes action to ensure patients receive the most appropriate level of care; actively participates in daily rapid rounds to coordinate care in conjunction with other members of the interdisciplinary healthcare team and provide and facilitate optimal health care/discharge planning; utilizes the nursing process (assess, plan, implement and evaluate) and management process (plan, organize, direct and control) to provide a framework for decision-making; maintains confidentiality of information; actively supports organizational goals and objectives by providing needed information to divisions and departments.

Job Description:

Essential Functions:

Under the direction of the Manager or Director of Care Coordination or CNO, the RN Case Manager performs activities which support the Care Coordination Department including:

• Promotes optimal management of clinical resources by conducting timely initial admission assessments based on clinical indicators and anticipated service needs for appropriate level of hospital care; Validates patient demographics and payor source

• Utilizes and contributes to the development of the multidisciplinary clinical assessment of patients on an on-going basis during the patient’s admission to ensure the quality and appropriateness of patient care

• Implements, reassesses, and evaluates patient condition and coordinates plan of care daily;  Develops patient specific plan of care based on the individual needs of the patients, conversations with providers and other staff, and documentation in electronic medical record (EMR.) Ensures updated plan of care is documented in the EMR

• Coordinates the discharge needs of patients with necessary internal and external providers while protecting patient information

• Performs timely, professional, and appropriate documentation as reflected in the Quality Review Audit process

• Advocates for patient/family needs in a respectful, non-judgmental, and confidential manner

• Serves as a liaison or facilitator for the patient and interdisciplinary healthcare team in the management of unusual or questions cases. Educates the healthcare team about the role of the RN: Case Manager.  Is accessible to the healthcare team as a resource.

• Appropriately refers cases to manager/director of care coordination, CAO, or medical director when intensity of service or severity of illness is not present and is unable to be resolved

• Ensure delivery of Discharge Medicare Important Message (IM) and Medicare Outpatient Observation Notice (MOON), where applicable

• Acknowledges, addresses, and completes are Consults to Case Management on respective units in EMR

Other Functions:

• Works collaboratively with social workers to identify social and financial barriers and community resources

• Completes referrals to Social Worker for patients with high-risk indicators

• Attends monthly departmental staff communications meetings. Serves as an active member of committees, as needed, which may include a variety of projects or topics

• Enhances professional growth and development through participation in educational programs, reading current literature, attending in-service meetings and workshops that are related to assigned areas of responsibility. Assumes responsibility of growth and development, maintains competency in care management principles

• Educates physicians, patients, and staff with regards to payors, financial issues, documentation, and potential compliance issues

• Serves as a resource to physicians for clinical management and financial issues.  Assists the providers with promoting efficiencies in the care delivery system and reducing/ eliminating barriers to efficient/effective service

• Maintains compliance with all company policies, procedures and standards of conduct

• Complies with HIPAA privacy and security requirements to maintain confidentiality at all times

• Performs other duties as assigned

A Note on Required Qualifications:

If individual holds an AS in Nursing they must be actively pursing their Bachelor's Degree in Nursing, Business, Health Care Administration or equivalent; Bachelor's Degree completion is required within 3 years of date of hire.

UofL Health will accept a Nurse Licensure Compact (NLC) from the NCSBN in lieu of a Kentucky Nursing License, per the KBN.

Additional Job Description: