Case Manager Certified - Transition in Care

FLSA STATUS

Exempt

EDUCATION

• Bachelor’s degree or higher from an accredited school of Nursing
• Master’s degree preferred

EXPERIENCE

• Five years hospital clinical nursing experience which includes two years in case management

LICENSES AND CERTIFICATIONS

Required

• RN - Registered Nurse - Texas State Licensure - Texas Board of  Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)
  and
• Magnet ANCC-recognized Case Management certification: ACHPN-HPCC or CCM or CMC or ACM-NBCM or CDCES or CHPN-HPCC or CMGT-BC or CM-ABOHN or CMCN or ANCC-NCM

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
• Comprehensive knowledge of Medicare, Medicaid and Managed Care requirements
• Comprehensive knowledge of community resources, health care financial and payor requirements/issues, and eligibility for state, local and federal programs
• Comprehensive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources
• Ability to work independently
• Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
• Demonstrates critical thinking and makes decisions using evidence-based analytical approach in interactions with physicians, payors, and patients and their families
• Competent computer skills of the entire Microsoft Office Suite (Access, Excel, Outlook, PowerPoint and Word)

PEOPLE ESSENTIAL FUNCTIONS

• Collaborates with the physician and all members of the multidisciplinary healthcare team to facilitate care for designated assignment; monitors the patient’s medical progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective.
• Independently and effectively communicates with physicians, multidisciplinary care team, patients, families and payers to ensure safe and timely transitions of care. Facilitates clinical conversations with payers to expedite authorization for appropriate post-acute placement based on the clinical condition of the patient.
• Serves as a preceptor and implements staff education specific to patient populations and department processes, coaches and mentors’ other staff and nursing students. Serves an expert case management resource for department and hospital. Provides education to physicians, nurses, and other healthcare providers on case management topics.
• Initiates contributions towards improvement of employee engagement as reflected by department scores, i.e., peer-to-peer accountability

SERVICE ESSENTIAL FUNCTIONS

• Proactively identifies discharge barriers and plans and anticipates/prevents and manages emergent situations. Facilitates timely assessment and intervention to prevent or reduce readmission; completion of treatment plan and discharge plan; timely modification of plan of care, based on clinical conditions and changes that may affect the medical treatment and ongoing discharge planning needs of the patient; assignment of appropriate levels of care;
  
  completion of all required documentation in designated EMR and applications or programs; elimination of discharge barriers
• Utilizes advanced knowledge and experience to advise and support care team members to creatively manage complex psychosocial or medical conditions, depending on scope of practice, and proactively formulate discharge plans to decrease avoidable delays.
• Stays informed and ensures compliance with CMS Conditions of…