Position Summary

Responsible for the implementation of the Case Management process. Monitors physician documentation and works closely with the medical staff for appropriateness of hospitalization. Identifies and evaluates quality of care, infection control, safety hazards, potential risk management and utilization problems. Reports findings to Director for dissemination to appropriate department and/or committees. Responsible for initial utilization screen and ongoing utilization review through discharge. Identifies discharge and transition needs and is ultimately responsible for the coordination of discharge planning activities. Works collaboratively with interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation process.

Primary duty of performing office or non-manual work directly related to the management or general business operations of the employer or employer’s customers. Primary duty includes the exercise of discretion and independent judgment regarding matters of significance.

Qualifications/Experience

Education: 

Graduate of an approved school of nursing. BSN encouraged

Experience: 

Minimum of 5 years of Medical Surgical Nursing. Case Management experience is preferred.

Licenses/Certificate:

RN and CPR

Essential Job Functions

To perform this job successfully, an individual must be able to perform each of the following Essential Duties satisfactorily.  Reasonable Accommodations may be made to enable qualified individuals with disabilities to perform the Essential Duties of the position, provided it does not create undue hardship on SARH.

• Observe professional ethics in maintaining confidential information acquired regarding person, financial, medical or employment of patients, families, and employees of SARH.
• Must follow and enforce accepted safety practices for patients and SARH.
• Must report hazards and initiate appropriate action.
• Must participate in safety instructional programs.
• Make patient rounds with and without physician to discuss the needs of the patient.
• Review the medical records daily to complete utilization review documenting Admission Justification and Ongoing Plan of Care.
• Arrange for facility cooperation in the performance of the delivery of care and awareness of psychosocial needs for resolution of individual cases.
• Interview patients, family members, and significant others to summarize immediate level of comfort and pending problems that present as a deterrent to delivery of care.
• Acts as a liaison between patient, family, significant other, and hospital staff during periods of crisis.
• Communicates with nursing and medical staff in assessing the psychosocial needs of the patient to monitor and oversee the discharge plan.
• Communicates with patients, family, significant others in discussing the discharge need of the patient and any barriers in the completion of a safe discharge goal.
• Maintains current working knowledge of JCAHO, COBRA, EMTALA, OSHA and other regulatory standards.
• Maintains current, accurate documentation in the patient's medical record.
• Maintains current and accurate data collection related to the quality of the delivery of care of the Department.
• Maintain a working knowledge of and update community resources in areas of practice.
• Verifies that homebound education has been arranged for school-age minors, and initiates arrangements if necessary.
• Participate in reporting abuse or neglects suspected prior to hospitalization as indicated by hospital protocol. Reports findings to appropriate agency.
• Contacts attending physicians as needed to ensure patient medical information documented in medical record meets quality, and discharge criteria.
• Assumes ultimate responsibility in correct Discharge Disposition Coding in medical record.
• In reviewing medical record documentation, communicate with the attending physicians as needed to ensure the documentation represents the acuity of need of that patient to allow for appropriate reimbursement.
• Contacts attending physician to clarify patient’s medical information and discharge plans and identify potential needs.
• Inform the Director of CM on potential denials.
• Collaborates with the Director of Case Management and refers to Physician Advisor on difficult cases.
• Directly responsible for coordination of services indicated or required by the patient post-discharge, i.e., SNF, Nursing home, Home Health Care.
• Responsible for referring patients with special financial needs / requirements to the appropriate finance personnel.
• Assumes all other tasks or responsibilities as assigned by the Director.
• Participates in educational programs as appropriate and available.
• Attends and participates in monthly department staff meetings.
• Performs additional tasks as assigned.

This job description is a summary of the typical functions of the job, not an exhaustive or comprehensive list of all the possible job responsibilities, tasks, and duties you may be asked to perform when they are assigned.