Case Manager in San Angelo, Texas at Shannon Health

Job Summary

The Registered Nurse (RN) is responsible for facilitating the patient's hospitalization from preadmission through discharge. The RN coordinates with physicians, nurses, social workers, and other health team members to expedite medically appropriate cost-effective care. The RN advises the health care team and provides leadership as needed.

Performance: Position Specific Essential Functions

• Proactively assesses patients and establishes Discharge Care (DC) Plan. consults with and keeps unit/Interdisciplinary Team informed of DC plan. Documentation is completed in a timely manner.
• Performs Utilization Review accurately and refers cases appropriately for secondary review. Performs initial utilization review and continued stay reviews. Ensures status orders are in place and keeps insurance company informed for certification of days. Documentation is completed in a timely manner.
• Assesses the patient by collecting information about the patient's home situation and health care needs through direct client contact and other relevant sources to include family, caregivers, etc.
• Utilizes established criteria to determine appropriateness of Inpatient admission/status to ensure the appropriate level of care and assists staff with interpretation of the criteria, as indicated.
• Attends department meetings and participates in unit activities to stay informed.
• Provides "Choice Letter" and assists the patient with selecting a DME company, Nursing Home, Assisted Living facility, Home Health agency, Hospice, etc.; obtains signature on the choice Letter by the patient/family and ensures placement in the chart and documents.
• Provides adequate communication of relevant issues to the interdisciplinary healthcare team and initiates referrals to service providers as identified in the discharge plan. Coordinates discharge teaching.
• Ensures that the interdisciplinary care/discharge plan is consistent with the patient’s clinical course, continuing care needs and covered services and modifies, as indicated.
• Reports and discuss with attending physicians and or physician advisors the appropriateness of resource utilization, consultations, and treatment plan.
• Assists with establishing Advance Directives, Medical power of Attorney, etc. as indicated. Identifies and establishes legal guardian/decision maker.
• Utilizes the Patient/Visitor Safety Learning Report to document patient safety issues and complaints related to care.
• Encourages patients to actively participate in meeting short and long-term healthcare goals and identifies appropriate community resources and support services to assist the patient.
• Tracks and ensures that the Important Message from Medicare has been provided to the Medicare patient on admission and that a follow-up copy has been provided, initialed and placed in the chart.
• Reviews the patient's progress as described by the various disciplines involved on an ongoing basis to ensure an effective plan is in place.
• Ensures discharge prescriptions, orders, and appointments are made, DME, OP services, Nursing Home care, etc. have been arranged and discharge, transfer, and referral forms are as complete as possible prior to patient departure.
• Develops a discharge/care management plan in collaboration with other members of the healthcare team, the physician and 3rd party payers, as indicated.
• Communicates the plan with the patient and family/significant other and adjusts the plan based on the patient's progress, input, and needs.
• Performs other duties as assigned.

Qualifications

Education

• Required
  • High School Diploma, GED, or equivalent
  • Associate's degree in Nursing
• Preferred
  • Bachelor's degree in Nursing

Experience:

• Required
  • 3-5 years Clinical Experience as a Registered Nurse in a Healthcare/Medical setting
• Preferred
  • 2-3 years in a Supervisor Role

Certification/Licensure:

• Required
  • Registered Nurse (RN), with authorization to practice in the State of Texas
  • Basic Life Support (BLS) Certification
    • Must obtain within ninety (90) days of start date
• Preferred
  • Relevant national certification