The Case Manager/Discharge Planner reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
The Case Manager is responsible for proactively managing the continuum of care for all patient populations from pre-admission to discharge. The position supports collaborative professional practice with all members of the care team. The position champions optimal clinical outcomes along with appropriate and efficient resource utilization, and ensures patients and families proceed seamlessly throughout the course of hospitalization and post-discharge.
- Autonomously collaborates with members of the care team to optimize health care plans for individual patients and patient populations through the development and use of multidisciplinary plans of care and clinical pathways.
- Coordinates regular patient care rounds and multi-disciplinary discharge planning conferences to assess continuing care needs, discharge planning needs, and improve communication, collaboration and satisfaction among the patient health care team and with the patient.
- Interviews patients and family members (when appropriate) to assess patient's age, level of functioning, and linkage to community services prior to hospitalization, the impact of illness/accident, patient's emotional, spiritual and physical health, and patient's support system when coordinating plans for discharge. Identifies needs for patient education and coordinates with nursing.
- Coordinates timely discharge plans to meet post-hospital needs for recovery/care. Arranges appropriate follow up care, including scheduling post-hospital physician follow up appointments, and provides patient/family with linkage to community resources.
- Educates the patient care team on timely discharge planning, throughput, resource utilization, process breakdown, and care enhancement. Communicates a tentative length of stay to the patient health care team and patient.
- This position works closely with Utilization Management team to ensure responsible use of resources related to patient care and appropriate length of stay. Maintains a working knowledge of the utilization review process and its relation to discharge planning.
- Maintains appropriate charting on all patient interactions and care planning. Communicates with physicians to obtain orders and documentation required to initiate post-hospital care.
- Oversees the Medicare Important Message process and coordinates appeals as needed with the Professional Review Organization.
- Communicates appropriate patient information to HMO's, PPO's, and other third party payors to certify patients for services and equipment.
- Monitors indicators such as length of stay, delays in services, pathway compliance, quality and satisfaction outcomes for individual stays and patient populations. Works collaboratively with patient health care team to identify opportunities for improvement and implement best practice solutions.
- Stays up to date on industry best practices and maintains a network of professionals to exchange ideas and benchmark best practices. Looks for opportunities to learn new skills and new tasks.
- Routinely assists other team members as needed. Actively contributes to team goals by encouraging and helping each other perform to the best of their capabilities, developing and reaching goals together, recognizing the contribution of others and promoting positive working relationships.
- Works in various units or campuses in the NM Healthcare System as requested to meet patient needs.
- Identification of population served by this position: This position requires knowledge of the principles of growth and development over the life span, and the ability to assess data reflective of the patient's status. Includes being able to interpret the appropriate information needed to identify each patient's requirements relative to the patient's age-specific needs.
- Registered Nurse/Illinois Licensure - required.
- CPR certification
- 2-3 years clinical nursing experience - required
- Physical ability to perform functional requirements as detailed.
- BSN - preferred.
- 2 to 5 years position related experience - preferred.
- ACM or CCM certification - preferred.
- Knowledge of insurance guidelines, CMS requirements, and other payor
- requirements - preferred