Boulder Community Hospital RN Case Manager in Boulder, Colorado

POSITION SUMMARY

The Case Manager is responsible and accountable for coordination of patient services through an interdisciplinary process, which provides a clinical and psychosocial approach through the continuum of care. Through concurrent case management, patients will be assessed to determine appropriateness of admission, continued hospitalization, as well as appropriate level of care. Discharge planning will begin at the time of (or prior to) admission, and reassessed ongoing throughout the course of hospitalization. Quality and Risk Management issues will also be monitored for and reported as appropriate.

JOB QUALIFICATIONS

Education or Formal Training

BSN preferred

Special Qualifications (Licensure, Registration, etc.)

  1. Current Colorado RN license in good standing

  2. Case Management Certification preferred

Knowledge, Skill and Ability

  1. Must have ability to compile, evaluate and report statistics to members of the team, and utilize the information to facilitate process improvement activities. Strong communication skills are necessary for meeting facilitation, educational presentations, team collaboration and patient interviews.

  2. Must have strong analytical, critical thinking and organizational skills.

  3. Knowledge/understanding of community resources, policies and procedures.

Experience

Three to five years of recent clinical or case management experience in area of specialization preferred

MATERIALS AND EQUIPMENT DIRECTLY USED

  1. Office Equipment: fax, copier, phone, computer

  2. Evidence Based Practiced Guidelines

  3. Meditech

  4. Allscripts

WORKING ENVIRONMENT/PHYSICAL ACTIVITIES

  1. May be exposed to infectious and contagious diseases.

  2. Contact with patients under wide variety of circumstances.

  3. Subject to varying and unpredictable situations.

  4. Must be able to handle emergency or crisis situations and may perform emergency care.

  5. Occasionally subjected to irregular hours and pressure due to multiple calls and inquiries.

  6. Requires judgment/action that prevents injury to patients.

  7. Light physical efforts (lift/carry up to 20-25 lbs).

  8. Prolonged, extensive, or considerable standing/walking.

  9. Occasional lifting, positioning, pushing and/or transferring of patients.

  10. Occasional lifting of supplies/equipment.

  11. Requires manual dexterity and mobility.

  12. Occasional reaching, stooping, bending, kneeling and crouching.

  13. Must have normal range of hearing in person and on the phone.

  14. Requires ability to articulate verbally in a clear manner.

INTERRELATIONSHIPS

  1. Position requires excellent communication, interpersonal and public relations skills.

  2. Responsible for development of exemplary working relationships with patients, their families and representatives, physicians, insurance companies, coworkers and hospital staff.

  3. Responsible for representing the hospital with a courteous, positive and professional attitude; conducting duties and behavior with ENCORE! standards at all times.

  4. Responsible for maintaining patient confidentiality at all times, discussing only pertinent and necessary details or data with the appropriate people to provide excellent patient care and service.

SUPERVISORY DUTIES

  1. Takes lead role in directing disposition of patients and utilization considerations.

  2. Assumes leadership role to facilitate interdisciplinary collaboration.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  1. Professional Accountabilities

a. Adheres to ENCORE! values and customer service expectations.

b. Adheres to name badge/dress code compliance.

c. Effectively problem-solves and actively pursues resolution.

d. Directly communicates with staff, physicians, patients and families.

e. Role models leadership behavior through courtesy, respect and efficiency.

f. Coordinates patient care processes to achieve desired quality outcomes, and identifies/controls inappropriate resource utilization.

g. Facilitates patient and family education, and promotes continuity of care to achieve optimal patient outcomes. Assures patient rights by offering a choice when appropriate.

h. Reviews the patient plan of care with the multi-disciplinary team. Facilitates and participates in multi-disciplinary team care conferences for patients with complex problems. Communicates in the medical record and verbally with the team to coordinate interventions and facilitate continuity of care.

i. Daily communication and collaboration with the patient care staff to provide continuous assessment, evaluation and continuum planning to assure the patient receives the appropriate level of care at the appropriate time. Facilitates the implementation of nursing interventions as indicated by the multi-disciplinary team plan of care that enhances and compliments the skill level of the nursing staff.

j. Functions without direct supervision, utilizing time constructively and organizing assignments for maximum productivity. Arranges schedule to facilitate meeting with MD’s for patient care rounds, team meetings and other opportunities to improve communication.

  1. Utilization Management

a. Knowledge of all applicable federal and state regulations. Demonstrates a working knowledge of managed care and Medicare health plans as well as reimbursement related to post-acute services within the continuum of care.

b. Consults with MD section leaders for support in cases that continued stay is not appropriate, and case manager is unable to come to resolution by working with assigned physician.

c. Responsible for communicating with the department director LOS and financial information, as well as issues that may affect the Continuum of Care process.

  1. Continuum of Care Planning

a. The Case Manager will be responsible for:

Typical daily case volume is approximately a ratio of 18:1

b. Integrating the assessment of the need for post-hospital services and determination of an appropriate discharge plan for complex cases.

c. Educates patient/family as to options/choices within the level of care determined to be appropriate. Initiates and insures completion of all necessary paperwork.

d. Facilitates completion of orders as required prior to transfer of patient to the next level of care in a timely manner so discharge is not delayed.

e. Continuum of Care planning will emphasize education and collaboration with physicians, family members, clinical social workers, nursing staff, therapists and case managers from contracted payors when appropriate to determine discharge plan that will be of maximum benefit to the patient. Involve staff from next level of care in the treatment plan as early as possible to promote continuity and collaboration.

f. Reports all relevant information to the staff assuming responsibility in the next level of care.

g. Employees are expected to comply with all regulatory requirements, including Joint Commission Standards.

h. Is familiar with organization, department and job specific Environment of Care areas, including Life Safety, Utilities Management, Hazardous Materials Communications, Emergency Preparedness, Infection Control and Medical Equipment Failure.

i. Adheres to Standard Precautions as appropriate, which may include:

i) the use of protective barriers, as appropriate (e.g., gloves, masks, gowns, pocket masks, and/or safety glasses);

ii) handling and disposing of infectious waste appropriately; and

iii) hand washing as appropriate.

  1. Risk Management

a. Interface with department directors, Risk Management and patient representatives to identify potential QA or risk issues. Perform any necessary investigation, documentation and follow-up as required.

b. Participates in departmental SQI projects.

c. Must have clinical knowledge of the Labor and Delivery, Pediatric and Neonatal, Medical Surgical, and Oncology patient and process.

d. Must be able to functionally coordinate and discharge plan for all age groups, including but not limited to the unborn child through geriatric age groups.

e. Prioritize and demonstrate critical thinking skills in complex care situations.