Case Manager, Quality Management

Full Time
Potsdam, NY 13676
Posted
Job description

SUMMARY

Uses skilled interventions,(objective and subjective), clinical best practice knowledge, professional collaboration with the patient, physician, and multidisciplinary treatment team to plan care, achieve quality outcomes within a target length of stay, and negotiate appropriate reimbursement. Ensures the timely and seamless transition of patients through medically appropriate levels of care in accordance with licensure, regulatory scope and standards, established hospital polices, and procedures in a patient and family centered manner. Ability to be flexible and agile to meet the complex, dynamic healthcare environment while providing world class customer service to patients, families, internal and external customers of the organization.


STATUS: Per Diem

LOCATION: Float- CPH, MH, GH
DEPARTMENT: Case Management
SCHEDULE: Variable

ATTRIBUTES

  • Required: Current NYS licensure as an RN

  • Required: 5 years’ experience working in an acute care setting

  • Preferred: Certification in Case Management

  • Preferred: Experience as a community health nurse or case manager

RESPONSIBILITIES


Assessment/Documentation
Confers with attending physician/LIP as appropriate to make determination about the medical necessity for admission or continued hospital stay. Performs assessment to determine patient care needs during the acute phase of illness and post discharge needs. Documents patient interventions and outcomes timely and accurately in the medical record according to the standards of professional practice.

Collaboration: Integrates patient information from social worker, physician and other members of the healthcare team to collaboratively determine potential and actual risks to recovery and the appropriate next level of care. Collaborates with physicians, nursing, social work, and multiple disciplines, departments, payer, agencies to eliminate barriers to efficient delivery of care in the appropriate setting. Provides world class customer service to patients, families, internal and external customers of the organization.

Planning: Accountable for developing and coordinating the implementation of a safe, appropriate, and timely discharge plan and alternative plan following evidence based practice. Negotiates appropriate reimbursement, demonstrates fiscally responsible decision-making in a patient and family centered manner.

Coordinates/Facilitates: Access to services and patient care progression using best practice interventions that will produce favorable patient outcomes within the defined target LOS.

Regulatory: Uses the Physician Advisor per protocol for complex issues related to physician practices, utilization review.

EDUCATION LICENSES/CERTIFICATIONS Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran PHYSICAL REQUIREMENTS : M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.

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