The Registered Nurse (RN)/Clinical Case Manager is a licensed professional who possesses scientific knowledge and professional/technical skills. In collaboration with the patient, caregiver, support person, health care team, payer, and post-acute providers the RN Case Manager effectively utilizes the Case Management process to communicate and facilitate patient care along the continuum through effective resource coordination. The RN Case Manager serves as a patient advocate and promotes customer satisfaction. The RN Case Manager is responsible for orienting and mentoring others to unit/department activities and may serve as a preceptor. In addition, the RN Case Manager may assume the role of the lead nurse for a given shift, as assigned. The RN Case Manager participates in departmental and organizational performance improvement activities and appropriately communicates findings.
Coordinates the timely delivery of patient care that is consistent with professional practice standards including the ethical framework articulated by the American Nursing Association, American Case Management Association (ACMA), and the mission and values of City of Hope including, but not limited to:
· Assessing and anticipation of patient needs through evaluation of clinical data, previous history, communication with patient, family, support person, caregiver, and identification of home and social support.
· Evaluating the patient’s progress toward attainment of identified goals and appropriate modification and communication of the plan of care.
· Having knowledge of age-appropriate care that ensures the comfort, personal and environmental safety of patients as they transition to home or placement in acute, sub-acute, rehabilitation or non-acute facilities.
· Acting as liaison between hospital and payer in determination of appropriateness of admission and continued stay.
· Serving as a resource for the inter-disciplinary health care team which includes collaboration with Admitting, Financial Clearance, Patient Access, Clinical Social Work, Patient Business Services, contracting, Pharmacy, ancillary services, and providers regarding payer reimbursement, covered services (including coverage limitations/restrictions) and post-acute care options.
Planning indirect care that promotes patient safety, through discharge planning referrals in collaboration with the patient, family/significant others, caregiver, providers, and post-acute care providers, as appropriate.
· Ensures goals and post-acute care plan is developed based upon patient preferences
- Provides timely and comprehensive education regarding insurance determinations, covered services and limitations, and discharge plans to patients/families/caregivers/care team and appropriately disseminates information in a manner which supports language and literacy needs.
- Oversees care for a defined group of patients and leads case management efforts among the multidisciplinary team. Actively participates in huddles, rounds, and outlier meetings.
- Maintains current knowledge and awareness of organizational and regulatory standards, policies and procedures. % Participates in a collaborative, empowered work environment as demonstrated through teamwork and shared decision making processes.
- Effectively communicates with all patients, family members, caregivers, providers, and team members to meet organizational goals and to provide customer satisfaction.
- Maintains current knowledge and skills through attendance and participation in organizational and department meetings and continuing education activities. Dedicates no less than 30% of continuing education hours specifically to case management topics.
- Demonstrates fiscal responsibility by appropriate and timely use of organizational resources.
- Actively participates in performance improvement activities through data collection and/or participation in corrective action plans to continuously improve service delivery.
- Demonstrates City of Hope values in individual work performance.
The following shared, organization-wide competencies describe the desired behaviors that will facilitate success at City of Hope:
1. Communication - Expresses ideas clearly and constructively (written and spoken, upward and downward, one-on-one and with groups).
2. Customer Service - Seeks to understand customer needs and works to exceed customer expectations (internal and external).
3. Initiative - Looks for opportunities to improve performance; manages time, work, and relationships effectively and efficiently.
4. Professionalism - Treats others with respect; abides by the institutional values; displays a positive and cooperative attitude; adheres to the workplace Code of Conduct and compliance policies.
5. Stewardship - Identifies efficiencies to reduce redundancy and/or elimination of tasks resulting in savings of cost, resources, and or/time.
6. Teamwork - Works proactively and collaboratively with others to streamline work and achieve mutual goals.
Minimum Education: Bachelor’s Degree in Nursing
Minimum Experience: Three years current clinical experience in area of expertise preferred
Req. Certification/Licensure: Current RN License, BCLS Certification
Preferred Education: Preferred Courses/Training: Case Management Training Course
Pref. Certification/Licensure: ACM-RN, CCM
Preferred Experience: 2 years case management experience preferred
Skills/Abilities: Access data in computer data base Coordinate requests Delegate tasks Excellent oral/written communications and organizational skills Sensitivity to intercultural relations Software:
Machines/Equipment: Computer equipment Fax Printer/Copier Telephone Software: Epic Previous use of InterQual or MCG preferred.
Working / Environmental Conditions: Atmosphere and environment associated with office setting Occasional pressure due to deadline requirements and multiple phone calls/interruptions Exposed to material of a confidential nature on a regular basis.
Physical Demands: Light physical effort (lift/carry up to 10 lbs.) Prolonged sitting using telephone and compute