Overview Job Summary: Utilizing the case management process, the Integrated Case Manager (ICM) coordinates transitional care for the children/families for an assigned medical team. Responsible for effective coordination of care; the ICM collaborates with providers to ensure all patient stays meet the needs of the patient to discharge in a safe and efficient manner. Based on the needs of the department, the role also performs the functions of a Hospital Case Manager (HCM).
Responsibilities Understands and addresses the continued needs of neonate, infant, toddler, pre-school, school-age, adolescent and/or young adult patients in relation to growth and development as they transition home or to an alternate level of care.
Demonstrates teamwork within the department by assisting other staff members as necessary.
Integrated Case Manager: initial and ongoing assessment of the patient’s clinical situation (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 assessments using InterQual Criteria; documents all acute care admissions and length of stay concerns as potential denials when criteria are not met; collaborates with providers to discuss differences in level of care assignment; ensures appropriate services across the continuum of care; provides outreach calls or visits to patients to ensure 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.
Hospital Case Manager: performs all functions of the hospital case management role as required.
Education and Experience Associate's Degree in Nursing required
Bachelor's Degree in Nursing preferred
2+ years minimum of case management experience preferred; pediatrics, discharge planning, home care and/or related child/family care experience preferred
Knowledge, Skills and Abilities Independent judgment, analytical ability, systems thinking and strong interpersonal communication for working 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.
Knowledge of Utilization Management and InterQual criteria is preferred.
Computer skills in Word, Outlook, Excel and Internet; ability to learn hospital programs such as MIDAS, Epic and EHRs.
Understanding of how healthcare delivery systems impact patients and families.
Knowledge of patient care and case management theory and practice preferred.
Licenses and Certifications RN license (State of Wisconsin) required
CCM - Certified Case Manager (preferred)
Patient Care Responsibility Provide care appropriate to the patient population and as described in applicable policies and procedures.
Required for All Jobs This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job.
Employment is at-will. This document does not create an employment contract, implied or otherwise.
Children’s Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status protected by law.