RN Care Manager - Union Clinical Care Management

Conducts complete assessments, establishesappropriate plans, and initiates interventions within desired timeframes. Collaborates and negotiates effectively with patient, family, and team while striving to achieve patient and organizational goals with regard topatient’s care needs, choice and satisfaction when discharge planning/transitioning care. Utilizes patient/family strengths in the problem-solving process, involving the patient/family and team in the decision-making process beginning on admission and continuing throughout patient’s hospital stay.

Provides continuity of care and discharge planning services compliant with regulatory standards by providing coordinated relevant options and services based on assessed needs to ensure patient/family and healthcare team is informed and able to proceed with accountabilities in a timely manner. This includes participating in the communication process to facilitate a smooth transition for patient, family, and staff when patients are transferred.

Provides case management services related to various levels of health care, finances, housing, family discord, or illness adjustment, based department scope. This may include managing family dynamics and crisis situations in a timely and professional manner, using community resources effectively, and educating patient/family regarding access to and use of services.

Initiates internal and external referrals to assuretimely progression of care and transitions. Documents discharge planning interventions and utilization review activity per department and medical center standards in a timely manner. Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria as required by department standards.

Communicates effectively with the healthcare team. Works in partnership with Social Work and unlicensed support personnel to effectively establish and implement a safe plan of care. Serves as an active member of the MDR and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities.

Collaborates with managers, physicians, medical directors, advisory groups, and treatment teams for issues related to physician practices and best practices for the patient’s plan of care. Refers cases to physician advisor as needed to ensure efficient progression of care, accurate status, and compliance with regulatory guidelines.

Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on length of stay and community resources. Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays. Delivers CMS regulatory notices within CMS establishedtimeframes, as appropriate based on-site guidelines.

Develops and maintains productive relationships with community-based agencies and networks by representing Advocate Health Care in a positive manner working collaboratively, internally, and externally, to meet patient/family needs. Works in collaboration with Advocate Ambulatory Care Management and Continuing Health to meet common goals and outcomes.

Serves as an educator and expert resource to medical and hospital staff regarding admission status and acute care criteria, utilization management issues, care coordination and discharge planning needs, and relevant regulatory requirements.

Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.