Registered Nurse Care Manager- 4W (4 10hr days, rotating weekends)
Company: Boston Medical Center
Location: Boston
Posted on: September 20, 2023
Job Description:
POSITION SUMMARY:
Utilizing a collaborative process, the care manager will assess,
plan, implement, monitor, and evaluate the options and services
required to meet an individual's health needs, using communication
and available resources to promote quality, cost-effective
outcomes. The care manager helps identify appropriate providers and
facilities throughout the continuum of services while ensuring that
available resources are being used in a timely and cost-effective
manner in order to obtain optimum value for both the patient and
the reimbursement source.
The care manager is accountable for a designated patient caseload
and plans effectively in order to meet patient needs, manage the
length of stay, and promote efficient utilization of resources.
Specific functions within this role include:
Assessment - The care manager will collect in-depth information
about a person's situation and functioning to identify individual
needs in order to develop a comprehensive care management plan that
will address those needs.
Planning - The care manager will determine specific objectives,
goals, and actions as identified through the assessment process.
The plan should be action oriented and time specific.
Implementation - The care manager will execute specific
intervention that will lead to accomplishing the goals established
in the care management plan.
Coordination - The care manager will organize, integrate, and
modify the resources necessary to accomplish the goals established
in the care management plan.
Monitoring - The care manager will gather sufficient information
from all relevant sources in order to determine the effectiveness
of the care management plan.
Evaluation - At appropriate and repeated intervals, the care
manager will determine the plan's effectiveness in reaching desired
outcomes and goals. This process might lead to a modification or
change in the care management plan in its entirety or in any of its
component parts.
Position: Registered Nurse Care Manager- 4W
Department: Care Management
Schedule: Full Time, 4W ((4, 10 Hour Days, rotating weekends)
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Conduct a thorough and objective evaluation of the client's current
status including physical, psychosocial, environmental, financial,
and health status expectation. As a client advocate, seek
authorization for care management from the recipient of services
(designee). Coordinates/facilitates patient care progression
throughout the continuum.
- Works collaboratively and maintains active communication with
physicians, nursing, and other members of the multidisciplinary
care team to effect timely, appropriate patient management.
- Ensures appropriate clinical pathway assignment by staff
nurses
- Addresses/resolves system problems impeding diagnostic or
treatment progress.
- Proactively identifies and resolves delays and obstacles to
discharge.
- Seeks consultation from appropriate disciplines/departments as
required to expedite care and facilitate discharge.
- Utilizes advanced conflict resolution skills as necessary to
ensure timely resolution of issues.
- Collaborates with the physician and all members of the
multidisciplinary team to facilitate care for designated caseload;
monitors the patient's progress, intervening as necessary and
appropriate to ensure that the plan of care and services provided
are patient focused, high quality, efficient, and cost effective;
facilitates the following on a timely basis:
Completion and reporting of diagnostic testing
Completion of treatment plan and discharge plan
Modification of plan of care, as necessary, to meet the ongoing
needs of the patient
Communication to 3rd party payers and other relevant information to
the care team
Assignment of appropriate levels of care
Completion of all required documentation in TQ screens and patient
records
Maintain communication and collaborates with medical staff, nursing
staff, and ancillary staff to eliminate barriers to efficient
delivery of care in the appropriate setting. Completes utilization
management and quality screening for assigned patients.
- Applies approved utilization acuity criteria to monitor
appropriateness of admissions and continued stays and documents
findings based on department standards.
- Identifies at-risk populations using approved screening tool
and follows established reporting procedures
- Monitors length of stay (LOS) and ancillary resource use on an
ongoing basis. Takes actions to achieve continuous improvement in
both areas.
- Assess resource utilization and cost management; the diagnosis,
past and present treatment; prognosis, goals (short-and
long-term).
- Refers cases and issues to physician advisor in compliance with
department procedures and follows up as indicated.
- Communicates with resource center to facilitate covered day
reimbursement certification for assigned patients. Discusses payer
criteria and issues on a case-by-case basis with clinical staff and
follows up to resolve problems with payers as needed.
- Uses quality screens to identify potential issues and forwards
information to the quality review department.
- Identify opportunities for intervention
- Set goals and time frames for goals appropriate to the
individual.
- Arrange, negotiate fees for, and monitor appropriate cases and
services for the client.
Ensures that all elements critical to the plan of care and clinical
path have been communicated to the patient/family and members of
the health care team and are documented as necessary to ensure
continuity of care. Manages all aspects of discharge planning for
assigned patients.
- Meets directly with patient/family to assess needs and develop
an individualized continuing care plan in collaboration with the
physician.
- Collaborates and communicates with multidisciplinary team in
all phases of discharge planning process, including initial patient
assessment, planning, implementation, interdisciplinary
collaboration, teaching, and ongoing evaluation.
- Ensures/maintains plan consensus from patient/family,
physician, and payer.
- Refers appropriate cases for social work intervention based on
department criteria.
- Collaborates/communicates with external care managers.
- Initiates and facilitates referrals through the resource center
for home health care, hospice, and medical equipment and
supplies.
- Documents relevant discharge planning information in the
medical record according to department standards.
- Facilitates transfer to other facilities for care management
population.
Actively participates in clinical performance improvement
activities.
- Assists in the collection and reporting of financial indicators
including case mix, LOS, cost per case, excess days, resource
utilization, readmission rates, denials, and appeals.
- Uses data to drive decisions and plan/implement performance
improvement strategies related to care management for assigned
patients, including fiscal, clinical, and patient satisfaction
data.
- Establish measurable goals that promote evaluation of the cost
and quality outcomes of the care provider.
- Collects, analyzes, and addresses variances from the plan of
care/care path with physician and/or other members of the health
care team. Uses concurrent variance data to drive practice changes
and positively impact outcomes.
- Collects delay and other data for specific performance and/or
outcome indicators as determined by the director of outcomes
management.
- Documents key clinical path variances and outcomes that relate
to areas of direct responsibility (e.g., discharge planning). Uses
pathway data in collaboration with other disciplines to ensure
effective patient management concurrently.
- Participates in the development, implementation, evaluation,
and revision of clinical pathways and other care management tools
as a member of the clinical resource/team. Assists in the
compilation of physician profile data regarding LOS, resource
utilization, denied days, costs, case mix index, patient
satisfaction, and quality indicators (e.g., readmission rates,
unplanned return to OR, etc.).
- Report quantifiable impact, quality of care and/or quality of
life improvement as measured against the care management goals.
Conforms to hospital standards of performance and conduct,
including those pertaining to patient rights, so that the best
possible customer service and patient care may be provided.
Utilizes hospital's Values as the basis for decision-making and to
facilitate the division's hospital mission. Follows established
hospital infection control and safety procedures.
OTHER DUTIES:
Provide coverage for Admitting, Emergency Department, and/or other
unit-based Care Managers, as directed. Perform other duties as
needed.
The above statements are intended to describe the nature and level
of work performed. They are not intended to be construed as an
exhaustive list of all duties required of personnel so classified.
Employees may be assigned to other duties as required.
JOB REQUIREMENTS
QUALIFICATIONS AND ENTRANCE REQUIREMENTS:
- Licensure to practice as a registered nurse in the state of
Massachusetts, required.
- Graduate of an accredited BS program in Nursing with a minimum
of 3-5 years' clinical experience.
- CCM or related certification preferred or attained within 24
months from date of hire.
- Coordination and Service Delivery - The care manager will
understand confidentiality and the legal and ethical issues
pertaining to it; understand medical terminology, how to obtain an
accurate history; establish treatment goals; establish working
relationships with referral sources; develop treatment plans.
- Physical and Psychological Factors - The care manager will
understand methods for assessing an individual's level of
physical/mental impairment; understand the physical and
psychological characteristics of illness; be able to assist
individuals with the development of short- and long-term health
goals.
- Benefit Systems and Cost Benefit Analysis - The care manager
will understand the requirements for prior approval by payer; be
able to evaluate the quality of necessary medical services; be able
to acquire and analyze the cost of care; understand the various
health care delivery systems and payer plan contracts; be able to
demonstrate cost savings.
- Case Management Concepts - The care manager will understand
case management philosophy and principles; apply problem solving
techniques to the care management process; document care management
services; understand liability issues for care management
activities.
- Community Resources - The care manager will understand how to
access and evaluate the available resources to meet a client's
needs; will be able to develop new resources.
- Excellent interpersonal, verbal, and written communication and
negotiation skills Strong analytical, data management, and PC
skills.
- Current working knowledge of discharge planning, utilization
management, case management, performance improvement, and managed
care reimbursement.
- Understanding of pre-acute and post-acute venues of care and
post-acute community resources. Strong organizational and time
management skills, as evidenced by a capacity to prioritize
multiple tasks and role components.
- Ability to work independently and exercise sound judgment in
interactions with physicians, payers, and patients and their
families.
NursingCM
Keywords: Boston Medical Center, Boston , Registered Nurse Care Manager- 4W (4 10hr days, rotating weekends), Healthcare , Boston, Massachusetts
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