Case Manager RN - HCA Healthcare

The RN CM is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resourcemanagement and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team. The RN CM facilitates the progression and transition of care using established criteria and in conjunction with the multidisciplinary team. The RN CM will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resourceutilization.  

II.POSITION QUALIFICATIONS: 

1. Bachelor’s prepared RN with current state licensure. In lieu of BSN, RN must have 5 years case management experience and complete a bachelor’s of science in nursing within 2 years of hire date 

1. 5 years of nursing experience with 2 years critical care or 3 years nursing experience with 2 years case management experience preferred. 

1. Certification in case management, nursing, or utilization review preferred. 

1. InterQual experience, preferred.  

1. Ability to establish and maintain collaborative and effective working relationships. 

1. Ability to communicate effectively in oral, written and electronic formats. 

1. Demonstrates analytical and critical thinking abilities with proactive decision-making and negotiation skills 

III. General Essential Functions 

1. Provides case management services for both inpatient and observation patients as assigned 

1. Identifies patients who are at risk for adverse outcomes during the transition from one level of care/setting to another 

1. Performs a comprehensive assessment of psychosocial, medical and discharge needs of patients/family along with an assessment of resources appropriate and available to the patient/family 

1. Reassesses the patient’s clinical condition as indicated. Considers patient’s readmission status or risk of readmission and develops strategies to mitigate including education on appropriately accessing healthcare resources, preventative education, and community based resources.  

1. Coordinates the plan of care and drives the discharge plan by collaborating with the multidisciplinary health care team and in particular with the patient's physician to facilitate a successful care transition 

1. In partnership with Social Services, the RN CM is responsible for ensuring the post-acute medical needs and level of care are appropriate 

1. The RN CM is responsible fortimely referral to Social Services when risk factors for psychosocial determinants of health are identified 

1. Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals 

1. Evaluates progression of care using evidence-based tools and approved criteria (InterQual) throughout the episode of care; escalates progression and transition of care issues through the established chain of command 

1. Makes appropriate referrals to third party payer, disease and case management programs for recurring patients and patients with chronic disease states 

1. Facilitates patient throughput with an ongoing focus on an effective care transition, quality and efficiency 

1. Documents professional recommendations, discharge plan, care coordination interventions, and case management activities to effectively communicate to all members of the health care team 

1. Align patient’s needs with available resources to ensure a safe discharge / transition 

1. Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies 

1. Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered 

1. Directs activities to identify and provide for the needs of the under-resourced patient population to include patient education activities, patient assistanceprograms, and community-based resources 

1. Participates in performance improvement activities including, but not limited to,identifying,documenting and intervening when avoidable days occur 

1. Adheres to established policy and procedure and standards of care; escalates issues through the established chain of command timely 

1. Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives 

1. Serve as an advocate for patient's rights, needs, and values; ensuring that patients’ ethnic, cultural, or religious values, beliefs, preferences and needs are considered and aligned 

1. Demonstrates knowledge human growth and development, assessment, types of treatment, and care of patients appropriate to the ages of patients. .. 

1. Promotes internal and external customer services initiatives 

1. Utilizes critical thinking skills to meet needs of individual patients. 

1. Demonstrates ability to perform technical skills and procedures. 

1. Documents all patient care. 

1. Participates in Performance Improvement activities as assigned. 

1. Works with Business Office to manage issue.. 

1. Other duties as assigned