Position Summary

The RN Case Management Specialist assesses, plans, implements, coordinates, monitors and evaluates options to facilitate the continuum of care. The RN Case Management Specialist provides a full range of case management services in collaboration with a multidisciplinary team. The RN Case Management Specialist educates staff regarding effective allocation of the hospital’s resources while encouraging provision of high quality patient care and is cognizant of regulations and policies of all review organizations relating to billing of the fiscal intermediaries.

Primary Responsibilities

Reasonable accommodations may be made to enable individuals with disabilities to perform the primary responsibilities.

1. Perform thorough patient and family assessments / interviews on high risk patients.

2. Document assessments in a clear, concise and timely manner.

3. Assist with discharge planning by gathering and analyzing data pertaining to patient’s needs and available resources.

4. Participate in daily multidisciplinary clinical case conferences.

5. Facilitate a potential discharge date by collaborating with multidisciplinary team and communicating the potential date with patient and/or family.

6. Arrange services intended to restore patients to optimum social and medical capabilities.

7. Coordinate discharge and transfer arrangements in a timely manner.

8. Provide patient and family education, as needed, to assist with understanding and acceptance of treatment plan recommendations.

9. Assist patient and families in application for financial assistance programs.

10. Complete LA Quit with Us training regarding Tobacco Cessation and provide education to patients who are current tobacco users.

11. Assist physicians, patients, families, staff and other health care providers in providing care for patient populations that is appropriate, effective, and cost efficient.

12. Attend and actively participate in all departmental and interdepartmental meetings relative to Case Management, Social Services and Utilization review functions.

13. Collaborate with physicians and staff regarding appropriate level of care / utilization issues.

14. Participate in daily multidisciplinary case conferences.

15. Collaborate with House Supervisor for patient intake. The intake nurse triages clinical data for direct admits and transfers from other facilities for appropriateness of admission to the acute hospital using Interqual Criteria.

16. Maintains current knowledge of Case Management, Social Services, Utilization and Nursing issues through continuing education.

17. Acquires professional certification in area of Case Management after 2 years of hire.

18. Participates in professional activities in order to continue professional development.

19. Identify and refer potential Risk Management, Infection Control and/or Quality Management concerns to appropriate department.

20. Identify end of life issues and assist patient and/or family through this transition with social services collaboration, if needed.

21. Identify and reduce avoidable days in care and discharge through timely intervention with practitioners, members of the healthcare team, third party payers, and others as needed.

22. Assists RN Case Management Specialist II with monitoring Medicare readmissions, overseeing the completion of 2 Midnight certifications, and conducting high risk patient discharge education.

23. Maintains an awareness of impact on others in order to display a caring, sensitive approach to others as evidenced by listening, understanding and responding to the needs of patients, colleagues and supervisors.

24. Shows respect for customer needs by developing and maintaining an active willingness to participate as a Team member.

25. Implements job responsibilities in a manner that is sensitive to and supportive of the hospital’s cultural diversity objectives.

Competencies

1. Knowledge of CMS, DHH, TJC regulations and reporting mechanisms

2. Able to work with a diverse patient and staff population with knowledge and sensitivity to cultural and spiritual influences impacting patient care

3. Knowledge of state and federal programs and community resources that provide medical care and financial support to individuals

4. Knowledge of basic computer skills

5. Deductive reasoning and communication skills

6. Teaching skills

7. Ability to read, write, speak, understand and communicate effectively in English

8. Ability to use appropriate discretion in handling confidential material and information

Supervisory Responsibility

None.

Required Education and Experience

1. Graduate of accredited school of Nursing

2. Must be licensed as Registered Nurse in the State of Louisiana

3. A minimum of 5 years clinical experience

Preferred Education and Experience

1. Case management experience preferred.