RN Case Manager NE
Company: Cleveland Clinic
Location: Stuart
Posted on: May 12, 2022
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Job Description:
Monitors patient outcomes, optimizing resource utilization and
implementing continuing care plans to meet patients' post-discharge
needs. Works in collaboration with other members of the health care
team and external agencies to facilitate efficient patient
treatment along the continuum of care. Responsibilities: Monitors
patient outcomes, optimizing resource utilization and implementing
continuing care plans to meet patients' post-discharge needs.
Utilizes chart review, electronic medical record, patient/family
interviews, and interdisciplinary team as information sources.
Organizes, plans and prioritizes caseload to optimize care
coordination; provides intense Care Management for patients with
high risk factors. Evaluates discharge planning needs on admission
review. Collaborates with patient/family, physicians, nurses,
ancillary personnel and external agencies to develop safe,
individualized, and appropriate continuing care plans. Obtains
consent from patients for continuing care providers; initiates
timely referrals, discharges, and transportation arrangements.
Ensures appropriate information is provided to anyone responsible
for continuing care support. Identifies appropriate hospice
candidates and communicates with physician regarding options.
Reviews observation patients each day to determine appropriate
level of care and patient status; confers with Admitting and
Business Office departments regarding authorization issues as
needed. Evaluates use and scheduling of hospital resources and
intervenes to prevent over/under utilization. Identifies
opportunities to prevent avoidable days and reduce length of stay.
Identifies educational needs of patients, families and staff and
takes appropriate actions; assesses readiness for understanding and
assuming responsibility for ongoing care as needed. Identifies
avoidable hospital days and confers with director regarding
findings. Facilitates multidisciplinary communication to maintain
ongoing, positive relationships with healthcare team, patients,
families, payers/TPA and community providers; functions as a
resource to all customers to optimize care coordination and
resource utilization Initiates and leads team conferences to
achieve consensus regarding continuing care plans. Establishes
positive rapport with patients and families; supports
decision-making and advocates for patient to ensure advantageous
use of benefits. Utilizes knowledge of legal issues, COBRA
regulations and regulatory agency requirements; issues notices of
non-coverage, important message per CMS guidelines when necessary.
Initiates and completes level 1 PASRR screen for all patients going
to sniff level of care upon discharge. Makes appropriate referrals
to Social Worker. Provides timely and thorough review to insurance
companies/TPA. Documents assessments, interventions, patient
progress, education, referrals and insurance information in CM
progress notes in a timely, accurate manner, as per policy. Other
duties as assigned. Education: Effective August 1, 2013: BSN
required upon hire or within 3 years of hire for external hires and
internal hires moving from a non-RN licensed role to an RN licensed
role. Certifications: State licensure as Registered Nurse (RN).
Case Management Certification Preferred BLS through AHA Complexity
of Work: All employees are expected to meet the standards of
performance outlined in the Organizational-Wide Competencies listed
below as applied to the position: World Class Service Orientation:
Includes attitude, behavior, interpersonal skill, and problem
solving that enable an employee to respond to internal and external
customer needs and expectations in a positive manner. Adaptability:
Includes teamwork and flexibility needed to fulfill job
responsibilities including adapting to changes in work environment
and accepting supervisory feedback. Efficiency and Effectiveness:
Includes quantity and quality of desired work, as well as
organization skills necessary to perform successfully. Essential
Job Requirements: Includes adherence to all relevant policies,
procedures, and guidelines affecting the work environment,
including maintenance of required competencies and communication
skills. Supervisory Responsibilities (if applicable): Includes
overall accountability for assigned work group relative to
operational goals, personnel requirements, and budgetary
constraints. Note: The above stated duties are intended to outline
those functions typically performed by individuals assigned to this
classification. This description of duties is not intended to be
all inclusive nor to limit the discretionary authority of
supervisors to assign other tasks of similar nature or level of
responsibility. Effective verbal, written and computer skills. Work
Experience: 3-5 years clinical nursing required and 2 years
hospital Care Management experience preferred. Working knowledge of
MCG guidelines. Personal Protective Equipment: Follows standard
precautions using personal protective equipment as required.
Keywords: Cleveland Clinic, Palm Beach , RN Case Manager NE, Executive , Stuart, Florida
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