Case Manager

Overview

The Case Manager is accountable for coordinating the care and service of selected patient population across a continuum of care; ensuring and facilitating the achievement of optimal quality, clinical and cost outcomes; coordinating services and resources needed by the patient and family; and assuming a leadership role with the multidisciplinary team.

Responsibilities

Coordinates and collaborate with physicians, provider, multidisciplinary team and other health care professionals concerning patient’s goals, plan of care and progress.

Develop, implement, interpret and maintain work standards and procedures that are in compliance with ARH’s policies and governmental regulations and various regulatory agency requirements.

Maintain up-to-date knowledge in the field to allow recommendation of new services, products and equipment.

Assesses, develop, implementation, and monitors comprehensive plan of care through an interagency multi-disciplinary team process in conjunction with the patient and family internal and external settings.

Revise and adjust on a daily basis the plan of care to accommodate the needs of the individual patient based on continuing assessment of patient condition.

Assumes responsibility and accountability for the care plan and effectiveness and patient outcomes.

Assesses the appropriateness of the level of care; diagnostic testing and clinical procedures; quality and clinical risk issues; and documentation of medical record completeness.

In accordance with hospital sanctioned ISDA criteria and/or other established criteria, reviews all patient admission data to determine the suitability of the level of care.

Develop, implement, monitor and evaluate clinical pathways and clinical pathway variances.

Monitor patients progression through clinical pathways.

Communicates continually with patients, families, medical staff, caregiver and third-payors as necessary.

Assist the patients and families with the educational process prior to admission, during hospital stay and after discharge, as indicated.

Assures patients understand the third-party payer guidelines and to arrange discharge planning referrals as ordered by patients’ physicians.

Develops and maintains a positive work climate and supports the overall team effort of the hospital.

Assists in collecting and analyzing outcome data.

Performs other duties as assigned or directed.

Qualifications

BSN preferred with 5 years experience in a hospital/community setting;

or

Must complete BSN or degree in other related field within 5 years;

or

RN with MSN or degree in other related field with 3 years experience;

and

Must meet all Licensure and Certification in state working;

or

Must obtain Certification of Case Management Society of America.

Plus

Excellent oral and written communication skills

Must possess skill and proficiency in applying highly technical principles, concepts and techniques that are central to the nursing profession.

Excellent organizational skills.

Must have a valid driver’s license in state working

CASE MANAGER

Position Description

March 30, 2005

Page Three

Must travel to patients’ residences, agencies, network providers as necessary.

Required to be cross-trained in UR, QA, discharge planning, and infection control.