Case Manager Navigator - Houston, United States - MD Anderson Center

Description

The mission of The University of Texas MD Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.

The primary purpose of the Case Manager Navigator is to:

Develop an individualized plan of care by assessing, planning, facilitating and advocating for healthcare needs along the continuum of care to achieve optimal clinical, financial and operational outcomes.

The Case Manager Navigator coordinates with the Multidisciplinary Care Team and internal/external customers in the management of patient care to include appropriate hand off to the outpatient setting.

The role integrates and coordinates utilization management concepts, care facilitations, and discharge planning functions.

The Case Manager Navigator also provides assistance to patients, families, and caregivers, offering education and resources to remove discharge barriers and support a safe and efficient discharge.

KEY FUNCTIONS
Standards of Practice - Care Coordination

• Develops a relationship with the patient upon admission to establish a consistent point of contact for the patient throughout the inpatient admission.
• Serves as the liaison between internal and external team members regarding issues related to utilization management and /or coordination of care
• Facilitates the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement
• Identify payer related issues that may impact the continuity of care such as those patients with out of network insurance or those who may be underinsured
• Facilitate patient transitions between inpatient services and ambulatory care, collaborating with the Oncology Nurse Navigators (ONN) or provide outside resources if unable to follow up at MD Anderson
• Promote collaboration and communication among healthcare team members, other colleagues, and organizations to promote and protect the best interests of patients.
• Demonstrates ability to work independently and exercise sound judgment in interactions with physicians, members of the interdisciplinary team, internal and external customers, patients and their families
• Demonstrates excellent interpersonal communication and negotiation skills
• Demonstrates strong organizational and time management skills as evidenced by ability to prioritize and manage multiple tasks and role components
• Seeks consultation from appropriate disciplines as requested to expedite patient care and facilitate discharge
• Modifies patient plan of care and documents as required to meet the ongoing needs of the patient
• Communicates plan of care to the patient/family and members of interdisciplinary team and documents to assure continuity of care
• Utilizes navigation evidenced-based tools developed to assess patient, family and caregiver needs such as pain, fatigue, and performance status.
• Works collaboratively and maintains communication with physicians, nursing and other members of the interdisciplinary team to demonstrate effective, timely and appropriate patient care management and eliminate barriers to efficient delivery of care in the appropriate setting
• Responds to all consults in a timely manner
• Adheres to all departmental guidelines and polices that surround care coordination
• Work collaboratively with providers and medical team to ensure adequate documentation to support medical necessity of inpatient stay and level of care determinations

Discharge Planning

• The Case Manager Navigator is responsible for the oversight of Continuum of Care Planning for post hospital acute care services, including but not limited to, completion and facilitation of referrals, transfers and immediate post discharge follow up
• Participates in and /or conducts daily multidisciplinary rounds (MDRs) with members of the Interdisciplinary team of assigned units and twice a week in assigned outpatient clinics
• Frequent touch points with patients/caregivers to reinforce the hospital plan of care, including assessing changes in psychosocial, financial and emotional status occurring during the inpatient stay. Coordinate referrals for support services as appropriate.
• Confirm post discharge coordination or identify any potential barriers that may impede the patient's journey
• Maintains visibility on assigned units and interacts with Clinical Care Team, patients and families
• Provides regular updates on patient care coordination with the Clinical Nurse Leader or designee
• Issues second IMM Notice, Moon Notice, HINNs and Condition Code 44 notification and documents in OneConnect prior to discharge, as appropriate
• Escalate cases that have unresolvable barriers or lack medical necessity for continued stay
• Responds to Patient Needs Assessment, documents interventions, and clears from list within one business day
• Responds timely to requests to coordinate discharge services for unplanned discharges
• Communicates, both verbally and in writing, all Case Management interventions regarding discharge plan
• Maintains knowledge of available post-acute care services based on payer coverage guidelines
• Completes ACMA Compass training annually

Documentation

• Documents daily Case Management activities appropriately in EPIC to reflect interventions prior to the close of the business day
• Documents all discharge planning activities in EPIC as needed to include identified case management issues, progress towards discharge and barriers that might impede patient follow up
• Utilizes handoff tools in EPIC to ensure continuity of care with both other CMs and outpatient nurse navigators
• Facilitates authorizations for Rehabilitation transfers and ensures the preadmission Rehabilitation MCG (Milliman) review is completed by UR prior to transfer to the Inpatient Rehabilitation Service.
• Documents in EPIC the discharge care coordination information including name of agency with contact number, services to be provided and date and time services to start if applicable, i.e. I.V. antibiotics
• Identifies and documents avoidable days
• Signs in as Case Manager on all assigned patients
• Activates out of office notification on e-mail and voice mail with appropriate information prior to scheduled day off
• Demonstrates compliance with all state and federal regulatory requirements

Education Required:
Bachelor's degree in nursing (BSN).


Experience Required:
Five years professional nursing experience. One year of experience as an oncology nurse or case manager can reduce the requirement to four years.

May substitute required degree with an Associate's Degree in Nursing with seven years of professional nursing, case management or navigation experience.

Licensure / Certification Required:
Current State of Texas Professional Nursing License (RN). American Heart Association Basic Life Support (BLS)

It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law.