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RN - Case Manager BSN/Full Time-Days

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Company: Mountain States Health Alliance

Location: Johnson City, TN

Date Posted: April 7, 2014

Source: MiracleWorkers.com



Case Management is a comprehensive, coordinated approach to planning high quality patient care for all patients from the neonate, infant, pediatric, adolescent, adult and geriatric population (s). Case Managers function as the non-physician team leader and as such assume overall responsibility for coordinating services, programs and personnel necessary to maximize patient outcomes and quality care, ensuring efficient movement of the patient through the continuum of care, and minimizing unnecessary resource utilization in a selected group of patients. In order to perform this function, the Case Manager must have exceptional clinical assessment and intervention skills in order to oversee the care provided their assigned patient population. The Case Manager must review the patient's status daily and identify issues requiring intervention. They must anticipate, plan and discuss patient needs with the patient and family, physician, members of the interdisciplinary team, and third party payers.
As the non-physician team leader, the Case ...


Case Management is a comprehensive, coordinated approach to planning high quality patient care for all patients from the neonate, infant, pediatric, adolescent, adult and geriatric population (s). Case Managers function as the non-physician team leader and as such assume overall responsibility for coordinating services, programs and personnel necessary to maximize patient outcomes and quality care, ensuring efficient movement of the patient through the continuum of care, and minimizing unnecessary resource utilization in a selected group of patients. In order to perform this function, the Case Manager must have exceptional clinical assessment and intervention skills in order to oversee the care provided their assigned patient population. The Case Manager must review the patient's status daily and identify issues requiring intervention. They must anticipate, plan and discuss patient needs with the patient and family, physician, members of the interdisciplinary team, and third party payers.
As the non-physician team leader, the Case Manager must ensure appropriateness and timeliness of medical interventions and ancillary services. They are to ensure a collaborative and team approach to patient care in order to minimize delays in care delivery and ensure positive outcomes. As such, the Case Manager oversees the collection of appropriate data that identifies opportunities for improvement in service delivery and assists in improving the efficiency and effectiveness of services when appropriate. The Case Manager must work closely with physicians and intervene when barriers to care are encountered. In addition, the Case Manager will oversee clinical documentation in assigned patient groups to ensure documentation is complete and accurately reflects patient's status and medical interventions completed.
The Case Manager is responsible for ensuring ongoing communication and collaboration with payer sources, achieving appropriate pre-certification and ongoing concurrent certification such that MSHA is paid appropriately for services provided. As such, the Case Manager must have an in-depth knowledge and ability to apply various payer's rules and regulations, admission, discharge and continued stay reimbursement criteria and both Interqual and Milliman Guidelines. The Case Manager must ensure that patients are admitted appropriately, and that continued care is appropriate for their clinical needs in the appropriate place in the continuum. While the Case Manager must monitor resource management and cost effectiveness of care for their assigned patient population; patient safety and achieving positive clinical outcomes will always be the ultimate guiding force in the Case Manager's position.
As part of this role, the Case Manager must also oversee the discharge planning process - including plan development, implementation, education and acquisition of resources for a successful discharge. The Case Manager oversees utilization of patient care protocols and clinical pathways and ensures appropriate patient and family education has occurred prior to discharge.
Personal characteristics include cooperation, flexibility, imagination and resourcefulness. The Case Manager must have strong initiative, excellent judgment, good problem solving skills, and excellent interpersonal skills. The Case Manager must have very strong clinical skills in their assigned area. They must be able to influence others without direct authority over them, and have strong conflict resolution skills and acumen in dealing with difficult people.
The Case Manager is responsible and accountable case management of the assigned patients and directs others to assure Patient-Centered Care which is based on patient's needs, values, and choices. The nurse is expected to practice autonomously within the scope of professional standards, the rules and regulations established by the Tennessee Board of Nursing, and knowledge of the policies and procedures within Mountain States Health Alliance. He/she has a working knowledge of the nursing process and demonstrates skill in developing and guiding collaborative collegial practice that delivers safe competent care. He/she demonstrates sensitivity and understanding of the diverse cultural backgrounds of our patients and caregivers. The position involves maintaining current knowledge of evidence based nursing practice and the ability to demonstrate critical thinking skills in the implementation of all phases of the nursing process. He/she actively participates in continuous quality/performance improvement of patient care through data collection, as well as, interpreting/evaluating the data and planning actions. The RN serves as a professional role model as a caregiver, mentor, teacher and resource for peers and other providers. He/she demonstrates competency in the care of the (circle all that apply): Neonate, Infant, Child, Adolescent, Adult, Geriatric patient .

MSHA expects all team members to support the VOS initiative by demonstrating awareness of the VOS system and effectively applying it to his/her work.
Job duties of this position may require access to protected patient information (PHI). The team member will be accountable for appropriate use of the record and compliance with all confidentiality and security policy and procedures related to use, access, and disclosure of PHI.
REPORTING RELATIONSHIP
The Case Manager reports to the Manager of Patient Resource Management. In the absence of this Manager, the Case Manager reports to the Director of Patient Resource Management, or the person designated to perform this function. In addition, the Case Manager has a matrix reporting relationship to the SSU Director or Nursing Supervisor in the facility or area in which they are assigned.

, ,
1) Graduate of accredited school of professional nursing with a current license in the appropriate state.
2) A baccalaureate degree in nursing
3) Varied clinical experience is preferred
4) Experience in Quality, Case Management, Utilization Review or similar field is preferred
5) Demonstrates the following attributes
a) In-depth knowledge of patient care process
b) Skills in collaborative care
c) Excellent management communication, problem solving, decision making and critical thinking skills.
CONTINUING EDUCATIONAL REQUIREMENTS:
1. Willing to assist with a minimum of two hours of job related educational programs.
2. Obtains 12 hours educational credit.
3. Identifies relevant patient care and/or nursing practice KIQ's (key indicators of quality). This is achieved by using PDCA methodology and the appropriate data collection, aggregation, analysis and trending in the demonstration of measurable improvement outcomes.
4. Attends 75% of staff meetings and reads 100% of the minutes of the meetings missed.
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