Case Manager, RN, Cohen Children's Medical Center, Per Diem - CORPORATE

Responsible for facilitating the patient's hospitalization from pre-admission through post-discharge. Coordinates with physicians, nurses, social workers and other health team members to expedite medically appropriate, cost-effective care. Assesses, plans, oversees and evaluates the appropriateness of care across the acute care continuum. Applies clinical expertise and medical appropriateness criteria to resource utilization and discharge planning.

Responsibilities Include:
1. Coordinates and facilitates patient care throughout hospitalization.
• Performs a case management intake assessment.
• Orients the patient to the role of the case manager, the goals of care and expected length of stay.
• Discusses with attending physician and/or physician advisor the appropriateness of resource utilization, consultation and treatment plan.
• Participates in interdisciplinary patient care rounds.
• Discusses estimated length of stay, treatment and discharge plan with the attending physician, as indicated.
• Identifies and assists in removing any barriers to patient care (variances) and resolves these issues with appropriate departments and personnel.
• Coordinates and facilitates any transitional planning needs through the acute care continuum.
• Using high-risk criteria, makes referrals to social work as identified through the high risk screening process.
• Consults with the physician regarding physical therapy, nutrition, speech therapy, respiratory therapy and other ancillary services as needed.
• Collaborates with all members of the interdisciplinary team to assess, plan, implement, coordinate and monitor services required to achieve quality patient care and resource management.
• Serves as a liaison between patients, families, physicians, payers and other members of the interdisciplinary care team.
2. Coordinates and facilitates the discharge planning process.
• Initiates discharge planning by assessing the patient's needs and documenting the assessment on the interdisciplinary care team.
• Works collaboratively with the physician and interdisciplinary team to determine the patient's need for continuing care services.
• Ensures that the interdisciplinary care plan and the discharge plan are consistent with the patient's clinical course, continuing care needs and covered services.
• Conducts a case management assessment, which includes the patient's physical, psychosocial and financial needs and issues.
• Interviews patient or designated agent to assess discharge-planning needs.
• Involves patient and/or family in discussion and planning for anticipated need for care following discharge.
• Ensures that the discharge plan is safe and timely.
• Completes all paperwork and/or ensures that all paperwork is completed and distributed in a timely fashion.
• Ensures patient and/or family are given information regarding their choices regarding transfer to another level of care according to regulatory standards.
• Ensures that all continuing care services including transportation, durable medical equipment, etc. are appropriately arranged for and financially approved.
3. Performs concurrent utilization management.
• Using established criteria, reviews appropriateness of patient's admission, need for continued stay and discharge criteria.
• Discusses with attending physician and/or physician advisor the appropriateness of resource utilization, consultation and treatment plan.
• Ensures that patient meets acute care criteria during each in-patient day.
• In concert with attending physician, places patient on alternate level of care (ALC) status when appropriate.
• Responds to third party payer requests for concurrent clinical information providing all relevant documentation to ensure reimbursement within expected time frames.
• Disseminates documents of non-coverage when appropriate.
• Ensures compliance with current state, federal and third party payer regulations.
• Works collaboratively with on-site reviewers to transition patients to appropriate discharge settings.
4. Participates in the quality management of patient care outcomes.
• Identifies and collects quality data including pre-established quality screens, NYPORTS and core measures.
• Identifies quality issues and reports these to the Director of Case Management.
• Ensures minimum quality standards are met during each day of hospitalization.
5. Documents timely and appropriately in the medical record regarding the case management process.
• Documents on-going process of case management interventions and discharge planning including discharge assessment, planning with implementation, on-going evaluation, up-dates and case management outcomes.
• Provides summary note at time of discharge synthesizing the discharge plan and follow-up care needs.
• Completes appropriate portions of Patient Discharge Instruction Sheet.
• Completes and facilitates the completion of the PRI with other disciplines.
• Completes case management intake assessment form.
• Completes all other relevant documents including Patient Transfer Form.
• Documents on-going case management progress notes in the medical record.
6. Performs related duties, as required.

• Bachelor's Degree, required. Master's Degree, preferred.
• Licensed to practice as a Registered Professional Nurse in New York State. PRI Certification, required. Certification in Case Management, preferred.
• Minimum of five (5) years clinical experience as a Registered Nurse, required. Prior experience in utilization management and/or discharge planning, preferred.
• Strong clinical background and understanding of the preparation and post procedure monitoring requirements for diagnostic/radiological and/or surgical procedures. PC literate.
• Knowledge of Microsoft Office, Excel, and spreadsheet management, required.