NURSE CASE MANAGER PT

NURSE CASE MANAGER PT

Position Summary

Under general direction, protects, promotes, and optimizes health and abilities. Prevents illness and injury. Alleviates suffering through the diagnosis and treatment. Advocates for patients and their families. Ensures all actions taken in carrying out responsibilities support patient centered care.

Position Responsibilities

Unit Specific Position Responsibilities

• Identifies appropriate patients (or patient populations) for Case Management services.
• Assesses the patients and / or families to evaluate individual barriers, which prevent the patients from progressing through the continuum of care.
• Identifies current, potential, and ongoing needs of patients and implements, evaluates, and revises the plan of care as needed with the assistance of the interdisciplinary health care team.
• Maintains appropriate documentation of assessments, coordination activities, and progress within the plan.
• Reviews all inpatients for severity of illness and intensity of services to determine the necessity of admission and continued hospitalization. Works collaboratively with physicians, Executive Health Resources (EHR), other health care team members, patients, and families in providing the necessary services in the appropriate level of care setting.
• Coordinates all communications and review requirements for external agencies third party payers and Executive Health Resources (EHR).
• Reviews patients before they are admitted to a skilled care setting or skilled care status and advises physicians and other health care team members in matters of eligibility.
• Assists in the identification of patients eligible for Rehab and makes the appropriate referrals.
• Attends and coordinates the interdisciplinary discharge planning meetings or patient care conferences.
• Identifies measurements and coordinates data collection and analysis of the effects of case management and other patient care and cost-effectiveness issues, and assists in the resolution of identified problems. Presents the results to the Patient Care Review Committee and other groups as appropriate.
• Coordinates denial of services and appropriate appeal processes.
• Coordinates and maintains the data collection, data transmission, data analysis, and improvement activities associated with Joint Commission Core measures and CMS public reporting initiatives.
• Assists in the ongoing development, implementation, evaluation and improvement of clinical guidelines, protocols, clinical standards, and other strategies to effectively provide patient care and reduce unnecessary resources.
• Remains knowledgeable in and serves as a resource for state, federal and third party payer requirements.
• Establishes and maintains a means for communicating and collaborating with physicians, other team members, patients, and families.
• Represents department and serves on various committees, teams, and boards as assigned or on a volunteer basis.
• Maintains regular and reliable attendance.
• Performs related work as required.

Qualifications, Knowledge & Experience

Required Qualifications (Including any licensure, certification, education) :

Licensed as a Registered Nurse and authorized by the State of Iowa to practice nursing.

Graduation from a school of nursing.

Basic Life Support (BLS) training within 90 days of hire and must maintain throughout employment.

Mandatory Reporter training or within 90 days of hire and must maintain throughout employment.

BSN Degree.

Organizational Requirements :

Will maintain stroke education per regulatory requirements.

Preferred Qualifications :

Professional certification in nursing specialty.

Required Knowledge, Skills & Experience :

Proficient in communication skills.

Ability to pursue and foster a sense of team and partnership across all disciplines.

Ability to communicate effectively, in English, with diverse population groups.

Ability to be self-directed, flexible, and able to adapt to change.

Ability to communicate effectively in a professional and tactful manner with physicians, staff, patients and / or their representatives.

Ability to read and understand chart documentation.

Ability to demonstrate basic computer skills.

Ability to read, write and understand the English language.

Preferred Knowledge, Skills & Experience :

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