Overview
Promotes the development of high quality patient care in the most effective setting, balancing patient/hospital advocacy. Knowledgeable of third party payor issues. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate.
Responsibilities
Coordinates patient care across the continuum of care and maximizes and mobilizes all internal and external resources to facilitate the case management process for all assigned cases.
Provides a nursing assessment within 24‑48 hours of patient admission for clinically oriented services focused on mobilizing primary care physicians, hospital systems, patient/family and community resources directed towards facilitating a clinically safe and timely discharge.
Identifies problems and gaps in patient care when covering for unit case manager, suggests interventions, expedites interdisciplinary referrals, and ensures diagnostic testing is completed and reported within appropriate time frame.
Actively participates in patient care conferences as scheduled on nursing units when covering for the unit case manager.
Works collaboratively with medical staff, nursing and other therapeutic disciplines in developing and implementing a patient plan of care while covering for case manager; follows plan of care initiated by unit case manager and initiates initial plan of care for new patients assigned.
Clinically documents patient plan of care, progress, goals, and interventions according to Case Management Department, Federal, and State guidelines.
Maintains a professional working relationship with Managed Care Organization telephonic and on‑site reviewers and external reviewing agencies in monitoring course of hospitalization and need for post‑hospital services according to third‑party payor guidelines.
Returns all calls from managed care organizations occurring on day covering the case; communicates patient care information through Allscripts in a concise, accurate and timely manner.
Monitors utilization of resources, exercising professional authority to intervene when necessary with physicians/therapeutic disciplines to remove barriers that impact length of stay.
Communicates via Allscripts to unit case manager any issues identified while covering unit; demonstrates awareness of over‑ or under‑utilization of resources and responds accordingly.
Effectively identifies patients for complex management versus those with less significant needs; explores strategies to reduce length of stay and resource consumption within complex case‑managed patient populations.
Negotiates, procures, and coordinates services and resources based on third‑party payor criteria; works with patients/families/physicians to effect a positive length of stay outcome.
Maintains accurate patient/family contact within timeline required by department policy and explains case‑management role.
Communicates with other members of the healthcare team regarding patient needs, plan and responses; collaborates with primary care physicians and nursing to maximize patient independence.
Manages patient transitions through the system and transfers accountability to the appropriate person or agency upon discharge.
Reports issues of quality care to Outcomes Manager; participates in data collections for monitoring and tracking resource utilization and outlier stays.
Collects, organizes, and inputs data according to QRM quality indicators, quality screens and case‑management criteria.
Seeks opportunities outside the hospital system to improve knowledge base and skills in case management; demonstrates self‑motivation and leadership in achieving case‑management goals.
Attends department meetings when available; informs department secretary of any interchange of new referrals to maintain accurate statistical data.
Remains up‑to‑date with federal and state guidelines related to utilization management and discharge planning regulations, demonstrating accountability for adhering to case‑management policies and procedures.
Assumes responsibility for covering case‑management activities in absence of assigned case manager.
Communicates effectively with internal and external customers, respecting cultural diversity, using interpreters when needed; performs other duties as assigned.
Qualifications
Knowledge of disease management.
Three to five years of acute care nursing experience or one to three years of experience in utilization review and/or discharge planning.
Bachelor of Nursing Degree required (significant case‑management experience considered in lieu of a Bachelor degree).
Current Massachusetts RN license.
Pay Range
$37.86–$75.71
EEO Statement
Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.
Location
Saint Annes Hospital – 795 Middle Street, Fall River, Massachusetts 02721