Strength Through Diversity
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The Care Manager (CM) will be responsible for all aspects of case management for an assigned group of inpatients to determine the appropriateness of the admission and continued stay, assist in the development of the plan of care; ensure that the plan is implemented in a timely basis and identify the expected length of stay. The CM works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team as needed. The CM actively participates in specific clinical initiatives focused on reducing the length of stay (LOS), improved efficiency, quality and resource utilization. Assignment will be by units/clinical areas of practice and may require responsibility on other units/services
Duties and responsibilities include, but are not limited to:
a. Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization.
b. Performs continued stay reviews utilizing standardized criteria to justify continued inpatient stay.
c. Collaborates with Physician and other clinicians to expedite diagnostic testing, treatment and consultations.
d. Documents all clinical reviews.
e. Identification and documentation of variances affecting the LOS and the discharge planning process.
f. Conducts follow-up of any delays in treatment or reporting of results.
g. Planning/developing specific goals with the physician, interdisciplinary team, and the patient and/or family.
h. Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of care.
i. Documentation of outcomes achieved and identified internal and external barriers.
j. Identifies reasons for readmissions and collaborates with interdisciplinary team on strategies to reduce readmission rate.
k. Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum of care and (appropriate) discharge planning.
l. Interacts with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources.
m. Complete any forms necessary in the discharge planning process including (but not limited to) PRI, M11Q, 485, and as requested by the Social Service Department.
- Bachelor’s Degree in Nursing; Masters preferred.
- Previous experience as in homecare, long term care or utilization review preferred.
- Discharge Planner or Case Manager preferred.
- Manager or a minimum of 3-5 years’ experience as a RN in an acute care setting.
- Current NYS RN nursing license.
- CCM certification preferred.
- PRI Certification