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    case manager rn - Indianapolis, United States - Eskenazi Health

    Eskenazi Health
    Eskenazi Health Indianapolis, United States

    3 weeks ago

    Default job background
    Full time (w/ben) 11
    Description
    The Case Manager, RN is responsible for managing each patient's plan of care, monitoring for appropriate resource utilization, and coordinating the patient's discharge plan.

    Essential Functions and Responsibilities

    • Proactively contributes to Eskenazi Health mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County. Models Eskenazi Health values of Professionalism, Respect, Innovation, Development, and Excellence
    • Serves as the overall coordinator of care, collaborating with Social Work counterpart, Physicians, Interdisciplinary Team, Nursing, and patients/families to provide efficient services for those within their assignment
    • Responsible for managing each patient's plan of care, monitoring for appropriate resource utilization, and coordinating the patient's discharge plan
    • Serves as a patient advocate, delivering quality efficient health care
    Case Management:
    • Coordinates/aids the patient's care across the continuum
    • Collaborates/retains active communication with Physicians, Interdisciplinary Team, Nursing, and patients/families to ensure timely patient progression through the +plan of care
    • Addresses/resolves problems impeding diagnostic or treatment progress
    • Proactively identifies and resolves delays to discharge
    • Utilizes conflict resolution, critical thinking, and negotiation skills to ensure timely resolution of issues
    • Identifies strategies to reduce the length of stay and resource consumption within the targeted population
    • Assesses through personally interviewing patients and any other relevant sources to collect specific information in an attempt to identify individual needs and to develop a comprehensive plan of care that addresses medical, social, and financial needs
    • Collaborates with Transition Support Leadership and the Physician Advisor to identify cases that require special intervention
    • Documents avoidable days and quality indicators as appropriate
    • Actively participates in creating an action-oriented and time specific plan of care
    • Continually reassesses and monitors patient for change in condition warranting initiation of a clinical pathway, alteration in plan of care, or change in care acuity in an attempt to determine the effectiveness of the care plan
    Utilization Review:
    • Conducts/ provides oversight of the initial admission review, utilizing appropriate criteria, within 24 hours of the patient's admission to the hospital to ensure appropriateness of the assigned level of care and timely implementation of the treatment plan when appropriate
    Financial Assessment:
    • Educates Physicians, Interdisciplinary Team, and Nursing regarding payer sources and the role this plays in discharge planning
    • Communicates as necessary with the on-site private payer/managed care Case Managers
    • Addresses private payer denials as appropriate
    • Evaluates the active funding for each patient and communicates with Financial Counseling/Med Assist to facilitate the initiation of appropriate funding applications
    • Addresses financial barriers to healthcare/medical compliance with the patients/families when indicated
    Social Assessment/Discharge Planning:
    • Oversees all discharges for assigned patients and collaborates closely with Social Work for discharge planning
    • Facilitates discharges to post-acute services such as LTACs, Skilled Nursing Facilities, or Nursing Homes and discharge planning including Home Health Care and durable medical equipment
    • Documents relevant Case Management Process and discharge planning information in medical record appropriately

    Job Requirements

    • Current Indiana RN required
    • Minimum of 2 years health care experience; 2 years of clinical nursing experience preferred

    Knowledge, Skills & Abilities

    • Must demonstrate knowledge of the Case Management, patient education and managed care processes
    • Demonstrates effective communication skills and knowledge of disease processes and normal growth and development for all age groups, in order to ascertain an accurate understanding of the patient's symptomology
    • Competency in the following areas required:
      • Interpersonal, written/verbal communication, and negotiation skills
      • Diplomacy, flexibility, and professionalism
      • Cohesive networking with the Interdisciplinary Team
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