Position Summary

The Case Manager RN proactively consults with the interdisciplinary team which includes patient care staff, physicians, and patient support and family and community resources with physicians and the other members of the interdisciplinary team to ensure that patients are admitted and transitioned to the appropriate level of care, have an effective plan of care and are receiving prescribed treatment, and have an advocate for services and plans needed during and after their stay. They are to assure a smooth transition for the patient through appropriate levels of care to facilitate quality outcomes.

Essential Functions

• • Work closely with interdisciplinary care team to identify high-risk, complex patient cases; manage care, including referral management, care planning, post discharge planning and coordinating community-based and transitional care.
  • Conduct individualized clinical evaluations of patients, their health needs and concerns; develop personalized action plans, provide education ad issue referrals for case management programs, monitor patient’s progress in meeting established goals and modify care plans accordingly.
  • Develop a cohesive and strong team oriented relationship with physicians, nurses and other health care professionals; evaluate and report on patient health outcomes and work in partnership with interdisciplinary health care team to facilitate the best inpatient care.
  • Direct discharge planning process in support of treatment adherence and medication compliance; assist with transitions for patient’s discharged from an inpatient/observation stay to a facility or home to include coordinating services, including scheduling, transportation, and follow up.
  • Guide, intervene and advocate on behalf of patients, their caregivers, and or families in regard to navigating and comprehending the health care system; coordinate resources in the community to ease transition
  • Use effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to: Promote, improved quality of care and/or life, cost effective medical outcomes, decreased lengths of hospitals stays when appropriate and continuity of care
  • Prevent complications and hospitalization/readmissions when possible and appropriate
  • Perform prospective, concurrent and retrospective utilization reviews per InterQual criteria and national guidelines.
  • Collaborates with the Physicians in managing the patient’s length of stay or transfer and determining the appropriate level of care for the next phase of the patient’s care.
    • Ensures physician specific plan of care is being followed for all patients.
    • Reviews clinical findings and diagnostic reports, correlates medical record findings with patient assessment findings.
    • Ensures appropriate resource utilization relevant to the financial, regulatory, and clinical aspects of care; proposes alternative treatment to ensure cost effective and efficient plan of care when appropriate.

Minimum Qualifications

• BSN Graduate
• Must possess a current, valid Texas RN license.
• 3 years clinical case management/utilization review experience preferred.
• BLS certification