RN Case Manager

Primary Location:

Mary and Elizabeth - UMC

Address:

1850 Bluegrass Ave
Louisville, KY 40215


Shift:

First Shift (United States of America)

Job Description Summary:

About UofL Health:
UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center.
With more than 12,000 team members—physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals—UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.

Job Description:

Position Summary and Purpose
The RN Case Manager Weekend 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. 

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
 

Additional Job Description:

Job Requirements
(Education, Experience, Licensure and Certification)
Education:
•    Associates Degree in Nursing if actively pursuing BSN or bachelor’s degree in Business, Health Care Administration or equivalent with bachelor’s completion required within 3 years of hire date (required)
•    Bachelor Degree in Nursing or an RN with a bachelor’s degree in Business, Health Care Administration or equivalent preferred (preferred) 
Experience: 
•    Two (2) years of experience as RN (required)
•    Additional (1) year experience in discharge planning/case management experience in an acute care facility (preferred)
Licensure:
•    Current KY RN licensure or compact license with privileges to work in Kentucky (required)
Certification:
•    Basic Life Saving (BLS) accredited by the American Heart Association (AHA) (required)
•    Case Management Certification (ACM, ANCC-Nurse Case Manager or CCM) (preferred)

Job Competency:
Knowledge, Skills, and Abilities critical to this role: 
•    Must be able to adjust priorities quickly, organize multiple tasks simultaneously, and work interdependently with many levels of staff. 
•    Attention to detail
•    Must be able to adjust work hours depending upon departmental and organizational needs as determined by the director or manager or Chief Administrative Officer (CAO)
•    Promotes departmental goals of improved quality, improved patient outcome and conserving resources as evidenced by value enhancement activities.
•    Knowledgeable of state laws, CMS conditions of participation, and TJC standards regarding regulatory requirements for care management and discharge planning.
•    Strong organizational skills

Language Ability: 
•    Must be able to communicate effectively in both verbal and written formats

Reasoning Ability:
•    Able to critically think through complex patient situations, process improvements, evidence-based practice
•    Ability to break down problems or tasks; scanning one’s own knowledge and experience to identify causes and consequences of events
•    Possess strong problem-solving skills and proactively works to solve issues that arise
Computer Skills: 
•    Proficient in Microsoft Word, Excel and Outlook. 
•    Basic computer skills including the use of electronic medical records.

Additional Responsibilities:
•    Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
•    Maintains confidentiality and protects sensitive data at all times.
•    Adheres to organizational and department specific safety standards and guidelines.
•    Works collaboratively and supports efforts of team members.
•    Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.

UofL Health Core Expectation:
At UofL Health, we expect all our employees to live the values of honesty, integrity and compassion and demonstrate these values in their interactions with others and as they deliver excellent patient care by:
•    Honoring and caring for the dignity of all persons in mind, body, and spirit
•    Ensuring the highest quality of care for those we serve
•    Working together as a team to achieve our goals
•    Improving continuously by listening, and asking for and responding to feedback
•    Seeking new and better ways to meet the needs of those we serve 
•    Using our resources wisely
•    Understanding how each of our roles contributes to the success of UofL Health