The Registered Nurse (RN) Case Manager works collaboratively with multidisciplinary teams across the continuum of care to serve as patient advocates that support, guide and coordinate care for patients, families and caregivers.
Essential to the RN Case Manager role are the core values of patient advocacy, holistic assessment, care planning, and the empowerment of patients, families, and caregivers to self-manage whenever possible and be the main stakeholder in their healthcare.
The RN Case Manager ensures compliance with state and federal regulations and CMS Conditions of Participation.
The RN Case Manager in the acute care setting coordinates care recommendations provided by the multidisciplinary team to develop individualized plans that have a desired outcome of achievement of optimal health, access to services, and appropriate utilization of resources to meet patient needs to ensure that the patient gets the appropriate care in the most appropriate setting.
Effective acute care Case Management includes but is not limited to the following: Assessing patient needs while evaluating health risks; Developing a comprehensive discharge plan that meets all of the patient's needs; Coordinating all appropriate disciplines in the patient care; Optimizing utilization management of resources; Performing interventions to reduce hospital length of stays and decrease readmission rates; and Ensuring that all post-acute care services are arranged prior to discharge.
Job duties & responsibilities:
Contributes to decision-making and decision support as a member of the interdisciplinary team.
Aligns practice with the mission, vision and values of Adena Health.
Commits to ongoing learning and strives to improve competence in all areas of practice.
Facilitates transition planning across the care continuum by involving the patient, family, provider, and other healthcare team members.
Works with patients and families to promote self-management support of chronic diseases through individualized plans with short and long term goals.
Refers patients and families to appropriate post-acute services and community resources in coordination with the fellow members of the Care Team in accordance with state and federal regulations.
Identifies areas of opportunity to provide education to other professionals regarding barriers that patients and their support systems encounter as well as means to resolve those barriers as with mitigation strategies.
Identifies and addresses avoidable delay practice patterns that may require modification to support cost-effective care.
Recognizes and values the contribution of all disciplines.
Builds and maintains relationships that foster trust and confidence.
Follows escalation process as needed.
Promotes the understanding an use of advance care planning.
Respects and incorporates patients’ goals of care and treatment preferences while respecting available resources.
Utilizes the ethics committee or other resources to address bioethical issues impacting patient care.
Identifies and implements strategies for avoiding and/or managing unnecessary costs.
Manages cost of care with the benefits of patient safety, clinical quality, risk and patient satisfaction to provide recommendations and decisions that ensure optimal outcomes.
Embraces and incorporates innovation and technology to improve collaboration and patient outcomes.
Utilizes technology to identify and engage with patients/families/caregivers that may benefit from Case Management services.
Ensures that suspected cases of abuse, neglect or exploitation have been referred/reported to the appropriate parties and/or agencies.
Demonstrates the ability to balance resources with patient preferences.
Ensures compliance with organizational policy and regulatory requirements to securely transmit patient information and protect their health information.
Required Education:
Bachelor's Degree
Nursing
RN- Registered Nurse with Current Ohio License Certified Case Manager (CCM®) within 18 months of hire Basic Life Support (BLS)
Five (5) years recent clinical experience
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