RN Case Manager

The RN Care Manager performs the initial comprehensive assessment on admission in accordance with the Care Management Department policy, screening all patients by utilizing established tools for high risk indicators (i.e. AIMS, Geisinger, polypharmacy) to ensure high risk patient populations receive the appropriate supportive services for discharge to prevent readmission and assess all populations for potential discharge planning needs. Provides ongoing reassessment of needs throughout the hospital course. Performs UR activity per department policy.

Essential Functions and Responsibilities Includes the Following:                               

• Understands and adheres to the Hospital Performance Standards, Policies and Behaviors
• Completes a comprehensive initial assessment.
• Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.
• Performs all transitional planning activities including but not limited to:
  • Patient/caregiver education
  • Arrangement of all aftercare
  • Commercial payer involvement
  • High utilizer patient root cause
• Communicates and collaborates all relevant patient information to appropriate health team members.
• Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.
• Documents per department requirements.
• Participates in Performance Improvement activities as needed.
• Performs all UR activities per department policy:
  • Commercial payer reviews
  • Disposition determination,
  • Retro/self-audit
  • MC variance
  • Admission clinical review.
• Performs all other related duties as assigned

Education & Experience Requirements                                                                           

• BSN or related Bachelor's degree required
• 5 years clinical ED, critical care or med/surg experience required
• Previous case management experience preferred
• Knowledge of healthcare financial, regulatory, and payer issues preferred
• Knowledge of state, local, and federal programs strongly preferred
• Experience in use of Milliman/InterQual criteria
• Registered Nurse (RN) NYS license required
• PRI/Screen certification strongly preferred.
• C.C.M. (Certified Case Manager) certification preferred
• Computer skills essential

Core Competencies                                                                                                            

• Demonstrates ability to establish two-way communication by clearly defining expectations, communicating utilizing a variety of methods, actively listening to ideas and concerns and responding in an appropriate manner.
   
• Demonstrates ability to delegate responsibilities appropriately.
• Demonstrates ability to retain composure under stress and perform multitasking functions.

Physical/Mental Demands/Requirements & Work Environment                                    

• May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) data base and may be accessed through the hospital’s Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc.
• Must be physically able to walk, stand and/or sit for extended periods of time, with the ability to carry necessary equipment (i.e., IPad or laptop) on rounds. Must be able to perform difficult manipulative, arm-hand steadiness and hand-eye coordination skills. Must be able to meet all regulatory requirements. Demonstrates ability to follow written and oral instructions required for the position.
• Demonstrates ability to analyze multidimensional problems into component parts and sort out tasks in priority order to solve the problem.
• Must be able to see object closely and far away, hear normal sounds with some background noise. Communicates effectively verbally and in writing.

Primary Population Served                                                                                                

Check appropriate box(s) below:

• Neonatal (birth – 28 days)

• Patients with exceptional communication needs

• Infant (29 days – less than 1 year)

• Patients with developmental delays

• Pediatric (1 – 12 years)

• Patients at end of life

• Adolescent (13 – 17 years)

• Patients under isolation precautions

• Adult (18 – 64 years)

• Patients with cultural needs

• Geriatric (> 65 years)

☒All populations

• Bariatric Patients with weight related comorbidities

• Non-patient care population

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of The Hospital.

  The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).