Care Manager (7113)

Acts as principal liaison between emergency services, surgical services, nursing, finance, physicians, utilization review, and other members of the multidisciplinary team to ensure appropriate bed is assigned, patient care needs are met, and treatment plans are executed on the appropriate level of the continuum. Key

Essential Function Patient Progression: Manages level of care status, target length of stay, and updates bed board daily as conditions change. In conjunction with all physician providers, discharge planner, and nursing staff coordinates patient’s plan of care for appropriate sequencing of care/interventions; ensures appropriate order sets and standards of care are initiated. Develops/implements a proactive DC plan upon admission, with MD/DCP and according to patient needs; documents the same as required by facility.

Proactively identifies and removes barriers that impede the progress of care. Works with unit nursing team to increase awareness of and facilitate patient flow to ancillary testing and procedure areas. Provides on-going communication with patient/family and interdisciplinary staff to identify and resolve potential barriers to discharge, keeps patient and family informed of care plan.

Participates in multi-disciplinary rounding and coordination of services – Rounds with physician. Administrative Care Management/Revenue Cycle: Supported by UR/UM Specialist, Discharge Planner/MSW, CDI Specialist ensures completion of the following: Passes off clinical information for insurance communication to Authorization Team. Manages the patient’s status, working DRG, Target LOS, and Anticipated LOS as conditions change; updates bed board daily.

Collaborates with Discharge Planner to coordinate discharge plan related to patient needs and payor requirements. Daily/regularly verifies the level of care is appropriate for patient’s care needs. Identify readmission or at risk for readmission; collaborate with team and develop plan to identify reason for readmit; discuss potential readmission concerns with family and help coordinate ways to prevent.

Multidisciplinary Coordination: Demonstrates and maintains effective communication skills with the multidisciplinary health care team; builds collaborative relationships with all team members. Coordinates documentation efforts of physicians, nurses, and team members; reviews and transmits data to appropriate parties. Alerts physicians of cases requiring immediate review and/or discussion.

Essential Function Attends multidisciplinary rounds. Acts as a liaison between patient, family, physician, and interdisciplinary health care team regarding plan of care and progress towards goals. Leadership Operations: Serves as a consultant and educator with medical staff regarding status, placement, payor requirements, and utilization of resources.

Provides leadership to the health care team with an emphasis on coordination of patient care and throughput of patients. Proficiently uses modules of the Care Logistics system. Professionalism: Provides clear, concise, timely written documentation and updates information and computer data as required Prepares and maintains required reports, records, and files for operational, administrative, and compliance purposes.

Utilizes computer and information systems to enter format and retrieve data, generate statistics, computations, tables, charts, and graphs. Maintains professional credentials and education necessary to keep abreast and maintain a current knowledge of clinical/theoretical/case management principles, concepts and techniques, best practices, and current trends. Attends continuing education, staff development, and mandatory programs.

Participates in staff training and performance improvement activities and utilizes the results of the quality of care activities to initiate changes in practices. Participates in orientation of medical staff, residents, and students to promote an understanding of the admission, throughput, and discharge process. Provides data for research and administrative support for case management operations, special projects, and studies.

Physical Demands A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Physical Demand N/A Rarely Occasionally Frequently Constantly Weight Standing X Walking X Sitting X Lifting X Carrying X Pushing X Pulling X Climbing X Balancing X Stooping X Kneeling X Crouching X Crawling X Reaching X Handling X Grasping X Feeling X Talking X Hearing X Repetitive Motions X Eye/Hand/Foot Coordination X Qualifications Education Education Level Education Details Required/ Preferred Graduate of an approved Nursing program Required Work Experience Experience Experience Details Required/ Preferred Minimum 2 years experience clinical nursing experience in an acute care hospital, ambulatory care setting and/or managed care organization Required and Case Management experience Preferred

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