Overview Job title: Integrated Case Manager (ICM) coordinates transitional care for children/families for an assigned medical team. Responsible for effective coordination of care; collaborates with providers to ensure patient stays meet discharge needs in a safe and efficient manner. Based on department needs, also performs Hospital Case Manager (HCM) functions.
Essential Functions Initial and ongoing assessment of the patient’s clinical situation, including physical and behavioral needs.
Leads the implementation and management of a care coordination plan by collaborating with the care coordination team, family/caregivers, treating providers, hospitals and other facilities, community agencies and services.
Attends all patient rounds with assigned Provider teams.
Reviews outpatient cases to conduct daily level of care assessment using InterQual Criteria.
Documents acute care admissions as potential denials when InterQual criteria are not met; documents length of stay concerns as potential denials.
Collaborates with Providers on differences in level of care (LOC) assignment; uses clinical protocols, algorithms, and paths when available.
Ensures patients receive appropriate services across the continuum of care and continuity of care across service levels and among providers.
Provides or arranges outreach calls/visits to patients to ensure appropriate delivery and access to aftercare services.
Communicates self-pays and out-of-network payors to the financial clearance department.
Provides education to families about outpatient/observation level of care and potential co-pays.
Experience and Education Associate's Degree Nursing required
Bachelor's Degree Nursing preferred
Experience: 2+ years; 2-3 years of case management experience preferred
Previous experience in pediatrics, discharge planning, home care, and/or other child/family care preferred
Knowledge, Skills and Abilities Independent judgment, analytical ability, systems thinking and strong interpersonal communications to work effectively in complex systems.
Ability to collect pertinent clinical information while maintaining good rapport with providers.
Skill in interpreting clinical treatment information to link patients with providers and resources across the continuum of care.
Expertise in Utilization Management and understanding of InterQual criteria preferred.
Computer knowledge in WORD, Outlook, Excel and Internet; ability to learn and navigate MIDAS, Epic and other EHR systems.
Understanding of the impact of healthcare delivery systems on patients and families; knowledge of patient care and case management theory and practice preferred.
Licenses and Certifications RN - Registered Nurse (State of Wisconsin) required
CCM - Certified Case Manager; Commission for Case Manager Certification preferred
Other Job Information Patient care responsibility: Provides care appropriate to patient population as described in applicable policies and procedures.
Employment is at-will. This document does not create an employment contract, implied or otherwise.
Equal opportunity / affirmative action employer; we do not discriminate on race, color, religion, sex, gender, gender identity or expression, sexual orientation, national origin, age, disability, veteran status, or any other status protected by law.
Seniority level Mid-Senior level
Employment type Part-time
Job function Other
Industries Hospitals and Health Care