Slidell Memorial Hospital Registered Nurse (RN) - Case Manager - Days in Slidell, Louisiana
The Case Manager is responsible for assuring the patient receives quality care and that outcomes are achieved in a timely and cost effective manner. Collaborates with the social worker in the development of a plan for post acute needs identified in the Interdisciplinary Meetings. Has a knowledge of payor source implications for the discharge plan, resources and placement options to maximize a patient's successful discharge. Chairs and disseminates necessary clinical and social information to all members of the Interdisciplinary team. Major Duties: Meets organizational expectations as defined by the Employee Standards of Performance, hospital and department policies and procedures, and the hospital’s strategic goals. Verbalizes a clear understanding of continuous quality improvement and customer satisfaction measures and actively participates in improvement initiatives. Reviews all admissions coming into the hospital for appropriateness. Accurately evaluates every admission for appropriate level of care using Interqual Criteria. Follows all cardiac catheter patients and changes level of care status when necessary. Reviews all scheduled surgery case for LOC. Assist in discharge planning for ED, when needed, and provide necessary resources as needed. Utilizes an interdisciplinary process to assess, plan, and provide patient care for specific diagnoses from admission through after care. Coordinates and monitors progress toward established discharge goals in a weekly meeting of the Interdisciplinary Team to achieve a smooth transition from admission to discharge. Maintains good knowledge of available community resources to access for meeting individual patient needs. Communicates, within one day of admission, concurrent clinical review to outside payor sources to facilitate reimbursement for patient care services and documents authorizations, within 3 days of discharge, to ensure prompt billing. Is alert to and reports signs of abuse in all age groups to the appropriate agencies. Identifies delay in care and quality and/or risk issues and reports these to the Director of Case Management. Performs concurrent clinical reviews to determine appropriateness of admission, continued need of hospitalization, and appropriate level of care. In depth knowledge of payor sources impact on discharge needs. Promotes appropriate post-hospital utilization of resources, adequate education of patient and hospital staff, and decreased incidence of readmissions. Acts as a resource for patients and staff providing updates on care and options available for discharge. Attends educational meetings to keep current in field. Acquainted with functions of all hospital departments and medical staff. Identifies post discharge needs for placement or referrals as necessary on admission, develops a plan for post discharge needs and makes arrangements to meet those needs prior to discharges in a cost effective/high utilization manner. Facilitates patient’s smooth transition through the continuum by ensuring that all staff is educated, informed and aware of plans. Coordinates patient education for patients and/or families by assuring that all targeted patients and their family understand discharge plan, and how to access available resources as needed. Weekly case review of patients here greater than 3 days LOS for Medicare, Medicaid and third payor sources. Performs other duties as assigned or directed to ensure smooth operation of the organization. Education/Knowledge/Skills/Abilities:
Preferred: Previous case management experience or at least 2 years clinical experience as an RN. BSN from an accredited program for nursing education. Certified Case Manager. Required: Computer skills: Word, Excel and Outlook. Ability to assess information, apply critical thinking processes for course of action, and share this information with the medical team. Excellent interpersonal and written communication skills, ability to prioritize workload and develop efficient methods of managing time. Ability to work independently. Ability to use phone, fax, copier. Registered Nurse who has graduated from an accredited program for nursing education. 2 years clinical experience in an acute care hospital; 1 year experience in discharge planning, may be in home health or psychiatric setting; leadership skills. Licensure/Certification: Current licensure to practice nursing in the State of LA.