Job Description
LITTLETON REGIONAL HEALTHCARE
POSITION SUMMARY
JOB TITLE:
RN Case Manager
FLSA:
0 Exempt
0 Non-Exempt
DEPARTMENT:
Case Management/Utilization Review
GRADE:
SUMMARY AND ESSENTIAL FUNCTIONS:
The RN Case Manager facilitates coordination and development of individual plans of care in collaboration with patients, their families and the multidisciplinary medical team. The RN Case Manager serves as a liaison between a patient and his/her healthcare provider to receive high quality healthcare services. This includes, assessment and monitoring of post discharge needs and facilitating a timely, safe and effective discharge for the patients of Littleton Regional Healthcare.
The RN Case Manager initiates home health referrals, transfers to rehab facilities, transfers to tertiary care facilities and coordinating other outside agency services as needed to include durable medical equipment. The Case Manager collaborates with nursing staff, social workers, providers and ancillary staff to identify patient/family educational needs for discharge. The RN Case Manager will also assist patients in completing advance care documents when requested.
The RN Case Manager also serves as utilization review nurse to ensure that healthcare services are administered with high quality, cost efficiency and within compliance by reviewing and auditing patient treatment files, and ensure that patients do not receive unnecessary procedures, ineffective treatment or unnecessarily extensive hospital stay. The RN Case Manager will ensure that the patient is at the right level of care to ensure that patients meet criteria for Medicare, Medicaid and commercial insurances to ensure correct reimbursement to Littleton Regional Hospital.
The RN Case Manager will also serve as a resource with post discharge calls to help patients with medication reconciliation and education to reduce readmissions.
Essential Functions
• Assess patient needs, including physical, psychosocial, and social.
• Make referrals to hospital Medical Social Worker when needed.
• Concurrent review of patient's clinical information for efficiency.
• Ongoing review of precertification requests for medical necessity and communicates either telephonically or by faxing commercial insurance representatives.
• Facilitates coordination of comprehensive, individualized plan of care to include patient and families.
• Develops efficient discharge plans utilizing outside agencies such as home health, nursing homes, acute rehabs, and tertiary care facilities.
• Monitors patient outcomes and appropriate utilization of resources to provide high quality care in a cost effective manner.
• Facilitates implementation of discharge plan with accurate documentation and communication with all parties involved to include advance care planning documents.
• Works in conjunction with financial aid counselor and Medical Social Worker to help patients apply for Medicaid.
• Effectively communicates and works in collaboration with patients, families and all members of the healthcare team.
• Supports Littleton Regional HealthCare's Quality Improvement plan.
• Serves as a resource for the patient, family, and staff personnel when needed regarding hospital procedures, length of stay, level of care and discharge planning issues.
REPORTS TO: Case Management/UR Manager
SUPERVISES: None
INTERNAL AND EXTERNAL CONTACTS: All medical and hospital personnel, patients, families, and other outside disciplines related to coordination of transfers and discharges to include: nursing homes, home health agencies and other hospitals.
QUALIFICATIONS:
• Must be a Registered Nurse with current New Hampshire license.
• Must have the ability to apply nursing process to plan of care for patients across the continuum.
• BLS required.
• Must work with a collaborative/team approach.
• Must be organized and able to prioritize and manage time efficiently with a high patient assignment.
• Must demonstrate the ability to negotiate with various customer and resolve conflict in a timely manner.
• Must have working knowledge of medical terminology.
• Must have an understanding of levels of care and how to move patients along the continuum of health care.
• Must be familiar with electronic medical record systems.
• Must be familiar with Advance Care Planning Documents to include POLST forms.
• Must be familiar with community resources.
• Must be knowledgeable in Medicare and Medicaid guidelines.
• Notary Public preferred.
Experience/Specialized Skills:
• Minimum of three years of medical/surgical experience.
• Utilization review and discharge planning experience preferred.
• Excellent verbal and written skills.
• Ability to facilitate team and group meetings/activities.
• Work independently and have time management skills.
Required Education/Course(s)/Training:
• Advance Care Planning
Preferred Certification/Registration:
• Case Management Certification preferred but not necessary
PHYSICAL DEMANDS:
Sitting-2 hours/day Crouching-Occasionally Standing-2-4 hours/day Kneeling-Occasionally
Walking-2-4 hours/day Lifting objects-25lbs. Reaching-Frequently Visual Ability-Yes
Bending-Occasionally Hearing Ability-Yes Stooping-Occasionally Work above floor level-
None
WORK ENVIRONMENT:
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