Job Snapshot

  • Job Schedule
    Full-Time
  • Job Category
  • Date Posted:
    7/20/2019
  • Job ID:
    19009547
  • Job Family
    Case Management
  • Travel
    No
  • Shift
    1 - Day
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Shawnee Mission

Job Description


Description

RN Case Manager

Top Reasons To Work At AdventHealth Shawnee Mission

•         Providing faith-based, whole person care to Kansas City since 1962

•         Excellent health benefits, an onsite child care center and fitness facility  

•         Tuition reimbursement to support continuing education

•         Employee Referral Program

•         Largest health care provider in Johnson County with three campuses

Work Hours/Shift

2 x 12 Hour Weekend Day Shifts

Work 24 hours and get paid 36 hours

You Will Be Responsible For:

  • Effectively functions as part of a self-directed work team
  • Coordinates the integration of utilization management, care coordination and discharge planning functions for patient care to meet established level of care, length of stay goals and patient needs, complying with all associated regulatory requirements and policies
  • Mobilizes resources to achieve expected goals per the patient's plan of care and ensures that patient diagnostics are appropriate and necessary and completed with the established timeframe
  • Anticipates discharge planning needs; refers discharge planning and psychosocial needs to Social Worker and/or Case Management Assistant.  Facilitates coordination of services
  • Leads multidisciplinary team meetings for review of the patient's plan of care, utilization management and discharge planning, collaborating with team members to address patient needs and desired outcomes
  • Coordinates the care of patients:  Works collaboratively with the multidisciplinary team and ancillary departments to move patients efficiently through the continuum, optimizing positive patient outcomes
  • Assumes final accountability to ensure that care of the patient is appropriately coordinated to meet clinical and transitional needs at time of discharge
  • Communicates timely and effectively with third party payers regarding certification and discharge needs  
  • Effectively completes or delegates tasks related to delivery of the 2nd IM, Home Health Referrals, acquiring and tracking the Face-to-Face Evaluation, arrangements for home medical equipment, and assistance with purchase of medications and any other appropriate actions to aid in the execution of the discharge plan.
  • Maintains confidentiality of patient and business information
  • Identifies and manages risks, resolves issues as they arise; reports and documents adverse events and reportable conditions
  • Documents appropriately and timely in Cerner Care Manager and CPA as applicable
  • Assesses and refers appropriate cases to the Physician Advisor for review
  • Conducts initial, concurrent, and retro reviews as necessary for department productivity.  Conducts utilization review with external review agency representatives as required
  • Assesses appropriate level of service of assigned patients.  Informs and assists physicians to ensure appropriate documentation exists to support assigned level
  • Maintains knowledge and application of Evidence Based Criteria.  Able to identify and apply correct criteria to determine medical necessity and level of care
  • Demonstrates knowledge of regulatory guidelines and requirements for utilization management and discharge planning assessment as indicated by TJC, CMS, KePRO and other agencies 
  • Demonstrates proficiency in use of the electronic medical record and programs specific to the role 
  • Cooperates with changes in staffing schedules and workload in order to achieve department productivity standard.  Rotate holiday and weekend on-site coverage as assigned
  • Participates in Performance Improvement activities
  • Incorporates patient, physician, customer needs and concerns into decision-making and organizational action.
  • Evaluates patient satisfaction and intervenes/acquires resources to insure patient and family needs are met.
  • Serves as patient advocate and enhances a collaborative relationship between the physician and multidisciplinary team with the patient and family to maximize informed decisions
  • Review patient medical record for over, under, and inappropriate utilization. Review for justification of patient admission and continued stay. Conducts timely and accurate interventions and follow-through
  • Informs Patient Financial Services and Social Worker of patients in needing financial counseling 
  • Tracks and documents avoidable days; proactively intervenes when appropriate and/or warranted
  • Utilizes criteria for referring patients for long stay reviews and make referrals as indicated 
  • Proactively manages and/or assists with addressing denials 
  • Assists in training new hires.

Qualifications

KNOWLEDGE AND SKILLS REQUIRED:

  • Associates Degree in Nursing, BSN highly preferred
  • 2 Years minimum of Position-Related Experience in an Acute Medical Hospital setting within the last 3 years OR 2 years minimum of Care Management Experience in an insurance company setting.


Job Summary:

The Case Manager provides expertise for enhancing the quality of patient management and satisfaction, continuity of care and cost effective practice through effective and timely care coordination.  The Case Manager has accountability for care coordination, utilization review and discharge planning assessment.  The Case Manager performs varied duties relating to utilization management both concurrently and retrospectively, incorporating knowledge of hospital policies/procedures /protocols, state and federal regulations, and utilization criteria as established by the medical staff, and nursing/health care knowledge. They communicate findings to appropriate parties as indicated to facilitate the utilization review process or quality improvement initiatives related to utilization management (e.g. external review organizations, medical/organizational departments or committees). Additionally, performs care coordination and discharge planning functions related to moving the patient efficiently through the continuum of care, focusing on minimizing system barriers for timely and safe patient discharge to the next appropriate level of care.  The Case Manager assesses readmissions and assists the quality management process in identifying trends and establishing plans of correction where appropriate



This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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