Case Manager II

Job Requisition #: JR59332

End Date: 12/17/2021

Location: Elkton, Maryland

Position Type: Case Management/Social Worker, Nursing

Shift: Day Shift, Rotation Day/Evening

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PRIMARY FUNCTION:

Oversees the utilization of healthcare resources, including discharge planning to facilitate the achievement of clinical, quality, financial and patient satisfaction goals.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

UTILIZATION MANAGEMENT

Performs admission and concurrent review to identify medical necessity, level of care and appropriateness of setting using

established criteria and clinical guidelines within 24 hours of admission (excluding weekends/holidays).

Reviews the admission assessment, collaborates with primary nurse and other health care providers to ensure a multidisciplinary

plan-of-care is in place to meet identified patient care needs and desired outcomes.

Identifies system issues that serve as barriers to care. Participates in development and implementation of strategies to remove

barriers and facilitate performance improvement measures.

Monitors efficiencies in scheduling diagnostic procedures and coordination of treatments to facilitate achievement of effective

clinical, fiscal, quality and patient satisfaction goals.

Participates in multi-disciplinary team rounds on the assigned unit.

Collaborates with the unit medical director and/or physician advisor to facilitate achievement of clinical, quality, financial and patient

satisfaction goals.

Notifies the Physician Advisor when patient does not meet criteria for acute care hospitalization, pursues documentation to justify

continued stay with in 24 hours.

Presents MOON forms, Discharge IMM letter, Detailed Notice of Discharge Letter, Letter of non-coverage to patients and/or families

Communicates and secures continued stay authorization with Managed Care Organizations.

Serves as a resource to nursing and ancillary staff, providing education on utilization review processes as needed.

Trends potential barriers to patient advancement through the system, intervenes assertively and appropriately when necessary.

Identifies need for patient to be evaluated by other members of the health care team and takes appropriate action to facilitate.

CASE MANAGEMENT:

Identifies patients who have post-acute care, placement, and complex discharge planning needs based on a comprehensive assessment that includes physical, as well as psycho-social factors/needs.

Anticipates, initiates, and establishes a discharge plan for patients with post acute care needs, collaborating with the physician, nurse and other health care providers, the patient, their family/primary caregiver(s), third-party payers, and employer in accordance with established clinical guidelines, standards, and pathways.

Communicates patient needs and arranges services with appropriate resources after securing patient consent and choice of vendor. Takes ownership of the discharge process to expeditiously return the patient to the most appropriate post-acute care setting. Establishes time specific objectives, goals, and actions in conjunction with the patient and family, to meet identified needs. Builds trusting relationships with internal and external customers, i.e., physicians, nurses, patients and their families, vendors, payers, etc.

Organizes, secures, monitors, and modifies the resources necessary to meet the goals stated in the case management plan. The Case Manager confirms the continuation of patient care services across the continuum via phone follow-up with patients/family to ensure the discharge plan has been executed.

Alerts social work of all patients with potential placement needs and works to facilitate the provision of care in the most appropriate care setting.

Serves an an expert consultant to members of the health care team and works closely with assigned units to meet LOS expectations. Manages and accurately documents pertinent patient and case management data in Meditech CM Module. Updates plan of care every 48 hours

Assumes responsibility for professional growth, shares knowledge with co-workers and health care team members.

Performs assigned work safely, adhering to established departmental safety rules and practices; reports to supervisor, in a timely manner, and unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients or visitors.

Performs other related duties as required

PERFORMANCE IMPROVEMENT:

Reviews patients' progress with members of the health care team. Monitors use of clinical pathways, verifying appropriate use and progress toward identified patient care outcomes. Monitors compliance with National Patient Safety Goals within assigned unit. Participates in monthly unit-based PI meetings to improve compliance with National Patient Safety Goals and JCAHO on-going readiness efforts. Assists with data collection and implementation of action plans for CMS, JCAHO, AHA Quality Initiatives as well as CCHS defined measures.

Communicates to Nurse Manager/Nursing staff, data collection results and directs change needed to come into compliance. Collaborates with performance improvement to identify opportunities, recommend selections, and support PI initiatives to improve outcomes on assigned units.

EDUCATIONAL/LEADERSHIP REQUIREMENTS:

Demonstrates on-going commitment to the department by serving as a preceptor, providing in-service and/or educational presentations annually, and participating in unit-based PI initiatives to include organizational and regulatory monitors and/or measurements. Actively participates in department operational planning work groups.

Demonstrates commitment and leadership in specialty through membership in professional organizations such as ACMA

EDUCATION AND EXPERIENCE REQUIREMENTS:

Registered Nurse with related work experience in Utilization Management, Case Management and or Home Care preferred. . Some continuing education should be related to role enhancement and changes of clinical practice within assigned area.

KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS:

Strong interpersonal skills relative to both professional and lay interactions. Strong organizational skills.

Working knowledge of Performance Improvement activities. Working knowledge of data management/reporting practices

SPECIAL REQUIREMENTS:

Active MD RN Licensure, in good standing.

EEO Statement: Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.


UPDATE: ChristianaCare is committed to prioritizing the health and safety of our patients and caregivers. As we continue to meet the needs of our caregivers and our community through the COVID-19 pandemic, our commitment to health and safety requires that we take new steps to ensure a safe environment for medical care for our patients and a workplace that avoids preventable harm for our caregivers. For this reason, vaccination for COVID-19 is required for all caregivers at ChristianaCare and is considered a safety standard that is job-related and consistent with business necessity for all caregivers.

Why do WE offer careers full of possibilities?

For the Love of Health.

Inclusion & Diversity

At ChristianaCare, we’re committed to treating everyone with dignity and respect. We believe in a safe, inclusive work environment that fosters collaboration between caregivers from all walks of life. We know that each unique viewpoint is vital in delivering high-quality, safe patient care to everyone who walks through our doors. Our policies, benefits, hiring practices, employee resource groups, and corporate citizenship demonstrate our commitment to inclusion and diversity throughout our system.

Why do we embrace inclusion and diversity? For the Love of Health.

Our Values

We serve together in Love and Excellence. Our unique values, Love and Excellence are bold and powerful, and they are the reason why working for ChristianaCare is special. The behaviors associated with our values guide how caregivers interact with everyone they work with and make for an exceptional work experience. We believe that when you lead with Love, Excellence is inevitable.

Benefits

ChristianaCare’s comprehensive total rewards package is one of the most competitive in the region. We are proud to offer excellent benefits that reflect the organization’s commitment to being exceptional today and even better tomorrow.

At ChristianaCare, we provide access to high-quality and affordable benefits designed to meet our caregivers where they are. You can tailor your benefits to meet your needs now and adjust them as your priorities change.

Take advantage of ChristianaCare’s wide-ranging benefit offerings from supporting optimal health through medical, prescription, dental and vision coverage to valuable wellness and work/life programs, which include paid parental leave, coverage for infertility and assisted reproductive technologies, an employer-funded short-term disability program, and more.

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Our Region

A Great Place To Live

Our region offers a diversity of cultures, lifestyles, sports and entertainment events, housing options and educational opportunities. Located between Philadelphia and Washington, D.C., our locations provide easy access to two international airports, employment opportunities in a tri-state area, and proximity to some of the nation's top universities and colleges, as well as beaches in MD, DE and NJ!

Why Delaware? Why Maryland?
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We Serve Together

For the Love of Health

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