DEPARTMENT: OUTPATIENT CASE MANAGEMENT

F ACILITY: Affinity West Campus

WORK TYPE: Part Time With Benefits

S HIFT: Daytime

The Case Manager (RN) is responsible for coordinating care for simple discharge cases and help facilitate complex patients' care across a continuum with the social workers and facilitating and ensuring the achievement of quality clinical and cost outcomes. While completing job functions works closely with attending physicians, physician offices, business office personnel, nursing personnel, medical records personnel, third-party reimbursement representatives, some government agencies, all ancillary departments furnishing care or services to patients, families, or caregiver, the general public and all community resource agencies. In addition, the Case Manager negotiates, procures, and coordinates appropriate services and resources needed by the patients and intervenes, as needed, to address and resolve issues and/or concerns and facilitates patient flow through the health care system to include utilization, discharge planning, infection control surveillance, and quality data collection. While completing job functions, the Case Manager works closely with attending physicians, physician offices, business office personnel, nursing personnel, medical records personnel, third-party reimbursement representatives, some government agencies, all ancillary departments furnishing care or services to patients, families, or caregiver, the general public and all community resource agencies.

* Screens assigned patients for high risk resource management , patient education and/or care planning needs/ IPCM screens within 24 hours (M-F) and 72 hours (S-S). Attends daily rounds and huddles/ OPCM attends daily team huddles.

• Continuously reviews and reassesses assigned patients.
• Intervenes as appropriate to manage resource utilization and plan of care.
• Evaluates the failure/ success and trends in processes that can potentially result in prolonged hospitalization, readmission, or lack of continuity of care.
• Communicates with physicians and care coordinators regarding prior approvals and plan of care for the patient, informing the patient, physician or multidisciplinary team of any changes in the patient's benefit status.
• Acts as a resource and is available for consultation to organization and medical staff regarding benefits, implications and limitation of insurance payments, home care services, and appropriate resource management.
• Provides resource management interventions that conserve organizational revenue or maximizes reimbursement.
• Collaborates with inpatient care coordinators to assure appropriate care transitions to outpatient setting.
• Assists in educational programs for physicians, hospital personnel, and community (local and regional) on all CM activities.
• Investigates possibilities for improving resource utilization, cost containment, and healthcare plan appropriateness, providing information and suggestions to the Director.
• Facilitates access to test results and timely consultations.
• Assist with transfers to other facilities as per department needs.
• Documents patient care / assessment information into the patient medical record. Collects and enters outcome indicators to include unnecessary days and other information into the department software system.
• Collaborates with other departments and community agencies (local and regional) to plan and implement continuum of care activities.
• Reports problematic cases to the Infection Control practitioner or State Health Department as appropriate.
• Reports any issues to the proper chain of command and follows proper chain of command.
• Assists patients and families obtain equipment, supplies, and services from community and government resources through appropriate referrals.
• Provides special instruction and resource information to assigned patients/families.
• Assists in carrying out effective quality improvement activities, such as data collection and analysis of healthcare delivery systems within the organization and community to improve the services provided.
• Facilitates telemedicine physician / consultant visits for appropriate identified patients. IPCM and OPCM work together to facilitate telemedicine on all discharge COVID patients.
• Issues appropriated Federal and State letters.
• Assesses 30 day readmission patients in the hospital setting to identify root causes for readmissions, assist in data collection, and to foster collaboration on care plan to prevent further readmissions.
• Involves family/significant other in plan of care and decision making as appropriate.
• Provides service with respect for human dignity and the uniqueness of the patient unrestricted by consideration of socioeconomic status, personal attribute or the nature of health problems.
• Acts to safeguard the patient and the public when healthcare and safety are affected by the incompetent, unethical or illegal practice of any person.
• Demonstrates efficient, effective, and prompt responses to any unit/patient crisis situation.
• Accepts responsibility to establish and maintain conditions conductive to high quality case management care.
• Updates knowledge base in outpatient case management strategies and resource services including new procedures, medications , treatments, and general patient care by attending continuing education opportunities.
• Rotates to other departments/areas with a positive attitude.
• Keeps abreast of pertinent federal, and state regulations and laws and Tift Regional Health System, Inc. (“TRHS”) policies as they presently exist and as they change or are modified.
• Understands and adheres to: TRHS’ compliance standards as they appear in TRHS’s Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy; and HIPAA and TRHS policies regarding privacy and security of protected health information.
• Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
• Offers suggestions on ways to improve operations of department and reduce costs.
• Attends all mandatory education programs.
• Improves self-knowledge through voluntarily attending continuing education/certification classes.
• Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements.
• Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department.
• Volunteers/participates on hospital committees, functions, and department projects.
• Manages resources effectively.
• Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
• Makes good use of time so as to not create needless overtime.
  

* Associate's Degree in Nursing

* REGISTERED NURSE

Minimum of three years varied acute care hospital experience/discharge planning experience or comparable job related experience, preferred.