RN Case Manager - Lake Charles, United States - SWLA Center for Health Services

Description

Job Description

SWLA CENTER FOR HEALTH SERVICES

JOB DESCRIPTION

JOB TITLE: RN – Case Manager

DEPARTMENT: Nursing/Medical

SUPERVISED BY: Director of Healthcare Quality

SUMMARY:

The RN Case Manager provides a range of client-centered services that link clients with health care, psychosocial support, and other services. The goal of medical case management is the provision of care coordination in the PCMH to ensure optimal medical outcomes are achieved by PCMH patients. This position enhances the quality of the Care Teams ability to provide proactive patient management, increased patient and provider satisfaction, continuity of patient care, and cost effectiveness through integration of case management, utilization review and management, and discharge planning.

EDUCATION, TRAINING AND EXPERIENCE:

1. Possess BLS certification. If applicable, must have CEUs or equivalent contact hours for re-licensure or recertification.
2. Answer the telephone using proper phone etiquette, speaking clearly and calmly.
3. Communicate effectively in person, by phone, and in writing.
4. Respond to emergent situations and difficult patients in a calm and professional manner.
5. Document all telephone conversations and patient contact related to the patient's assessment in the EMR in an accurate, clear, and concise manner.
6. Accurately carry out and document providers' orders in the EMR.
7. Interpret providers' orders accurately to patients, pharmacies, staff, and other medical facilities.
8. Work independently as well as with providers and staff.
9. Demonstrate knowledge of basic computer and EMR skills.
10. Maintain strong confidentiality, understand patient privacy rights, and adhere to HIPPA requirements.

JOB RESPONSIBILITIES:

1. Identify high risk patients such as inpatient discharges, chronic disease, and non-compliant patients (high acuity and complex cases) for case management intervention and assists the Care team with coordination and delivery of cost-effective, quality-based health care services.
2. Works with the provider care teams by utilizing internal and external data sources, identifies and contacts patients identified though various practice protocols and initiatives.
3. Coordinates care in the PCMH track and supports patients when they obtain services outside the practice.
4. Provides ongoing support and expertise through comprehensive assessment, planning, implementation, monitoring, and evaluating plans of care and outcomes measurement in coordinating the healthcare continuum for individual patients.
5. Assumes accountability for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care, thereby improving the overall care outcomes of the patient.
6. Responsible for providing support to patients, their families, and physicians in addressing medical and social concerns.
7. Educated patients and families to assist them to make informed personal health care decisions.
8. Assists the care team and patient in the implementation and ongoing evaluation of patient self-management goals.
9. Interfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning, and alternative treatment plan development if necessary.
10. Understands and follows policies and procedures and produces and submits reports in a timely manner.
11. Serves as a professional resource to other members of the multi-disciplinary care team. Initiates and assists with the multi-disciplinary care planning process.
12. Maintains excellent communication within the care teams. Documents actions in the patient's medical record as appropriate.
13. Collaborate with clinical staff and social workers as needed in the development and execution of the plan of care, and achievement of goals.
14. Serves as a patient advocate. Acts as a liaison between the patient care team, healthcare facility, and community agencies.
15. Assists in establishing and implementing all Case Management policies and procedures and functions as staff support for PI committees.
16. Reads at least one educational article related to Case Management per month.
17. Other related duties as assigned.

PHYSICAL DEMANDS- SEE ATTACHED

MISSION AND CUSTOMER SERVICE:

1. Demonstrate the Mission and acts in ways that advance the best interest of the customers entrusted to our care. Positively represents SWLA Center for Health Services (SWLA) in the workplace and the community.
2. Present a professional image: apparel and appearance are appropriate according to SWLA department dress code.
3. Demonstrate effective communication and listens attentively to the customer and promptly acts upon requests with consideration for patient privacy. Keep the customer informed about their care and treatment in a comfortable atmosphere.
4. Respect the gifts and talents (the diversity that co-workers bring to their jobs) of each other. Demonstrates effective communication and assists co-workers as necessary.
5. Respect the privacy and confidentiality of the customers we serve, our physicians, co-workers and the community.
6. Practices safe work habits and maintain a safe environment for self, co-workers, patients, and visitors.
7. Work collaboratively to solve problems, improve processes, and develop services. Acts as an advocate for our customers.
8. Complies with organization/department policies and procedures, including but not limited to confidentiality, safety, cooperation/flexibility and attendance.
9. Understands and complies with applicable federal/state laws and Standards of Conduct as related to assigned job duties.
10. Participates in departmental or organizational quality. Continuous performance improvement activity.