RN Case Manager – Discharge Planning & Utilization Review – PT

The Case Manager Discharge Planner/Utilization Reviewprovides focused discharge planning, initiated as early as possible after admission, to facilitate timely and appropriate discharges in collaboration with the patient, family, and clinical care team. They furtherutilize the nursing process for age and diagnosis of specific populations to assess, plan and evaluate the care of a designated case load of patients so that clinical and financial outcomes are achieved.

Flexible schedules to cover all shifts and weekends, as hospital needs demand.

Provides focused discharged planning, initiated as early as possible after admission, to facilitate timely and appropriate discharges.

• Maintains current, accurate information regarding community resources to facilitate discharge planning.
• Identifies patients with complex discharge planning needs arising from diagnoses, therapies or psychosocial or other relevant circumstances.
• Documents discharge planning activities in the medical record.
• Facilitates transfers to appropriate higher level of care facilities when services are not available based upon the facility’s Scope of Care (e.g., pediatric or neonatal intensive care).
• Includes alternative care facility placement, DME, family involvement and community resource referral in discharge planning activities.
• Directs and delegates activities associated with executing the discharge plan to appropriate personnel.

• Communicates clearly and accurately in both verbal and written form.
• Consistently demonstrates tact, diplomacy, sensitivity and professionalism.
• Exhibits appropriate telephone protocol.
• Adheres to proper channels of communication in a courteous and cooperative manner.
• Acknowledges each patient complaint within the shift and takes appropriate action.
• Greets patients and visitors promptly and makes them feel welcome.
• Utilizes correct procedure in regard to hospital information systems and communication with ancillary departments.
• Actively participates in inter-disciplinary health team conferences.

• Identifies and corrects conditions that affect employee safety; upholds safety standards.
• Maintains stable performance under pressure or opposition; handles stress in a manner that is acceptable to others and to the organization.
• Makes customers and their needs a primary focus on one’s actions; develops and sustains productive customer relationships.
• Having achieved a satisfactory level of technical and professional knowledge in position related to areas, maintains current development and trends in area of expertise.
• Clearly conveys information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.

Maximizes positive financial outcomes for his/her designated case types.

• Develops and demonstrates organizational skills and effective time management skills on a daily basis.
• Compares and contrasts resource utilization before and after a planned change.
• Identifies and implements changes/strategies to improve profitability of targeted case types.
• Ensures optimization of reimbursement through assignment of proper coding for specific cases.
• Monitors and analyzes variances from standard and individualized clinical paths.
• Assesses efficiency and cost effectiveness of interdepartmental systems.
• Identifies and communicates problems/inefficiencies in interdepartmental operations to the Director, Case Management.
• Assists the Director, Case Management in planning, implementing and evaluating strategies to correct/improve problems/inefficiencies.
• Performs and/or delegates admission and continued stay review for all payers and levels of care; performs these responsibilities within 24 hours of admission and continued stay reviews not less than every three (3) days.

Utilizes consistent processes to assure that all patients are evaluated and monitored for appropriate resource consumption.

• Applies utilization review criteria objectively for admissions, continued stay, level of care and discharge readiness, using…