Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The Case Manager is responsible and accountable for ensuring high-value patient care that is coordinated, efficient, and aligned with institutional clinical and financial objectives. In collaboration with the healthcare team, the Case Manager utilizes evidence-based practice to ensure that specific patient outcomes are reliably achieved and that resources are appropriately used within designated fiscal time frames. With our members of the health care team, the Case Manager participates in the ongoing evaluation of practice patterns and supports efforts to improve patient care and enhance the efficiency of operations. The Case Manager interacts with others in the identification of trends and barriers to all aspects of care. Through this interaction, the Case Manager identifies and works toward a resolution as a part of the multidisciplinary team.

EEO/AA/Disability/Veteran
Responsibilities

• 1. As part of the interdisciplinary health care team, coordinates and ensures the implementation of the plan of care, utilizing the principles of case management.
• 1.1 Establishes a system for coordinating the care of a patient throughout the continuum of care, linking the inpatient care with outpatient care, services, and case management.
• 2. Optimizes the efficiency of hospital systems which impact quality and/or length of stay
• 2.1 Identifies and monitors compliance with documenting variances from established parameters in the clinical pathway or treatment plan.
• 3. Utilizes information obtained from various resources available to:
• 3.1 Ensure that each patient meets the clinical needs for admission, treatment, and discharge and initiates appropriate follow through with the health care team.
• 4. Assist clinicians in documenting the appropriateness of admissions and continued stays
• 4.1 Responsible for Medicare notices of non-coverage and help provide appropriate documentation to appeal inappropriate denials.
• 5. Ensures that an appropriate discharge plan is developed and implemented with the health care teams members to include:
• 5.1 Identifying service, treatment, and funding options;
• 6. Ensures that the discharge plan provides a continuum of care with the appropriate outpatient physician and needed services.
• 7. Ensure that the appropriate outside agencies are contacted and necessary referrals are initiated and followed through.
• 7.1 Links patient and family with the appropriate institutional or community resources, advocating on their behalf for scarce resources, and developing new resources where gaps exist in the service continuum.
• 8. Works collaboratively with PSM and unit leadership team to actively involve clinical nurses in the assessment and planning for patient's discharge to facility.
• 9. Along with other members of the health care team, acts as a patient advocate.
• 9.1 Exhibits awareness of ethical/legal issues concerning patient care and strives to manage situations to reduce risk.

Qualifications

EDUCATION

Minimum of a Baccalaureate degree in clinically related field. R.N. required

EXPERIENCE

Minimum of three (3) years of relevant clinical experience

LICENSURE

RN Licensure in Rhode Island required. Additional RN licensure in CT preferred.

SPECIAL SKILLS

Recent appropriate nursing experience, theoretical knowledge of the nursing process, case management and continuity of care. Advanced communication and interpersonal skills with all levels of internal and external customers. Ability to obtain and interpret information appropriate to patient needs and age. Advanced assessment and teaching skills. Leadership skills in planning and managing patient care as acquired through greater than 3 years of clinical nursing experience in an acute care hospital. Utilization management and case management experience preferred. Knowledge of computer software and hardware applications and a basic knowledge of statistics.

PHYSICAL DEMAND

50% sedentary; sitting, standing, walking from unit to unit, carrying records, speaking before groups. Must be able to speak and hear in a manner understood by most people. Must be able to communicate effectively by telephone.

Additional Information

Previous care management experience.

YNHHS Requisition ID

115017