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Summary Reports to the Manager, Case Management. Meets with patients/family/significant other to assess post hospital needs and facilitates linkage with appropriate community services and resources. Ensures patients have a well-planned process in place from admission to discharge or transfer of care for medically complex patients. Collaborates with the interdisciplinary team to assess clinical readiness for transfer and discharge. Ability to communicate positively and effectively with all levels of participants in health care delivery in both formal and informal settings and with individuals as well as groups of varying size and through documentation. Clinical expertise appropriate for designated patient population. Nurse Case Manager and Clinical Social Worker work together to identify complicated social and medical situations and provide interventions necessary for patient based on assessed needs. Skill in auditing outcomes concurrently and retrospectively. Capable of managing complex workload and establishing priorities. Maintains up-to-date knowledge of reimbursement processes and community resources. Provides clinical and discharge data necessary to insurance companies to ensure that postdischarge needs are addressed.
Mission, Values, and Service Goals MISSION: We deliver outstanding care, inspire health, and connect with heart.
VALUES: Trust. Respect. Integrity. Compassion.
SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.
Responsibilities Assessment/Identification Of Needs: Continually assesses total population in assigned area re: discharge planning needs and LOS, social and financial needs. Completes assessments on admission and through discharge. Responds in a timely fashion to referrals for case manager intervention. Assesses overall process of referrals on assigned units and recommends interventions to improve when appropriate. Documents patient assessment promptly and completely. Works with patient and family to provide necessary education and facilitation of linkages with community services and resources. Provides/refers for financial counseling as appropriate. Provides interventions for patients to ensure compliance such as Meds to Beds, vouchers, home health care.
Discharge Planning: Develops in conjunction with other disciplines and in a timely fashion appropriate discharge plan. Investigates availability of community resources and presents recommendations to physician/patient/family/significant other. Documents patients/family understanding acceptance of/or alternatives to discharge plan on Discharge Planning Record. Facilitates referral/contact with appropriate resources to meet discharge needs. Demonstrates effective problem solving in conflicts or complex discharge planning situations. Leads efficient, effective routine discharge planning meetings and other conferences related to discharge planning. Participates in rounding or discharge planning meetings with physicians and other team members. Schedules conferences between the patient/family and physicians and other disciplines as appropriate. Discusses obstacles to goal attainment with patient/family and providers and advocates for problem resolution. Assists nursing and physicians to facilitate transfers to other acute care hospitals. Works effectively with medical staff to optimize appropriate resource management. Advocates for patients with payers to obtain coverage for needed services. Ensures all mandatory Medicare notices are delivered and signed. Demonstrates understanding of insurance and managed care processes.
Counseling/Education/Department Support: Serves as resource to patient/family/significant other/staff and physicians re: community resources and post-acute services criteria. Identifies psychosocial and environmental needs related to admission, treatment and discharge. Provides information on financial resources, healthcare benefits. Demonstrates knowledge for handling special situations and cross-trains to various units and functions within the department. Requires knowledge of community agencies, services, entitlement programs, and financial resources on federal/state/local levels to assist patients and families.
Contribute To The Overall Effectiveness Of The Department: Completes other job-related duties and projects as assigned. Demonstrates a positive team approach to patient and departmental issues.
Organizational Responsibilities: Attends and participates in department meetings; completes mandatory education, annual competencies and department-specific education; maintains license/certification; ensures BCLS and other certifications as required; adheres to safety, regulatory, and organizational policies; overtime and schedule flexibility as required.
Education And Experience: Nursing program from an accredited school of nursing with current Indiana RN license, or BSN/MSW; candidates hired after Jan 1, 2014 must have or obtain a BSN within five years; minimum 3–5 years of job-related experience.
Knowledge & Skills: Interpersonal skills; plan of care and discharge readiness oversight; psychosocial issue identification; clinical process knowledge; navigating complex service systems; strong communication across all levels; knowledgeable about Medicare notices and reimbursement processes.
Working Conditions & Physical Demands: Acknowledges potential mental stress; physical ability to perform essential functions including standing/walking, lifting as needed, CPR capability, and related tasks.
Job Details Seniority level: Entry level
Employment type: Full-time
Job function: Other
Industries: Hospitals and Health Care
South Bend, IN $80,000.00-$85,000.00
South Bend, IN $80,000.00-$85,000.00