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RN Case Manager - Omaha (Full-time) 8a-4:30p

Madonna Rehabilitation Hospital Omaha, NE
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Job Description

JOB DESCRIPTION
 
Job Title:  RN Case Manager - Omaha                                                  Job Code:  800078  
Immediate Supervisor:  Director Case Mgmt- Hospital Programs                Status: Exempt                                        
 
DEPARTMENT FUNCTION/JOB OVERVIEW
 
The Case Manager is responsible for the collaborative team process which assesses plans, implements, coordinates, monitors and evaluates the options and services to meet the patientâ??s health needs, using communication and available resources to promote quality, cost effective outcomes.  These duties include the development of the patientâ??s overall plan of care including the identification, periodic review and revision, and communication of an individualized interdisciplinary plan of care.  The case manager is accountable for meeting quality patient outcomes and service delivery based on (1) appropriate length of stay, (2) effective utilization of resources including program utilization, (3) continuity through a continuum of care, and (4) established standards.  Additional responsibilities include serving as a liaison between patient, family, payer, team and physician; facilitation of education and training for patients, families and caregivers; for overall coordination of the patientâ??s program.  The case manager must adhere to the CARF standards for a case manager.  The case manager is responsible for providing leadership in quality service delivery and internal and external customer relations for Madonna as a whole upholding the mission and values for the department and facility. 
 
ESSENTIAL FUNCTIONS
 
(INFORMATION)
  1. Analyze patients past and current status; assess impairments, disabilities and handicaps in order to plan, coordinate, implement and monitor an effective and efficient plan of care.
  2. Analyze and monitor patientâ??s need for specialized tests, equipment, transportation, etc., in order to coordinate the provision of and payment for such services.
  3. Monitor the patientâ??s current status as well as information in the medical record, and assimilate/compare to professional nursing knowledge of disease, trauma or disability to evaluate and ensure the appropriate provision of care.
  4. Compile, synthesize and enter FIM data into E-rehab in order to facilitate accurate reimbursement and/or program evaluation reporting and analysis. 
  5. Analyze, assess and monitor the principal diagnosis, secondary diagnoses, and procedures assigned to the patient to evaluate and ensure accurate reimbursement in hospital programs.
  6. Analyze, assess and monitor the Patient Based Income Statement (PBIS) to obtain CMG or DRG length of stay to assist in the management of the patientâ??s length of stay and manage patientsâ?? financial information in order to maximize appropriate utilization of resources.
  7. Compile, coordinate and analyze patientâ??s program information in accordance with the requirements of third party payers in order to maximize appropriate utilization of patientâ??s financial benefits.
  8. Coordinate and compile information regarding patientâ??s status and outcomes, unplanned discharges and patient follow up to assess customer satisfaction, facilitate problem resolution, and contribute to evaluation of the program.
  9. Compile and analyze information to monitor patientâ??s response to the current treatment plan, assess available, clinically and financially appropriate alternatives in order to plan and implement appropriate placement in the continuum of care.
  10. Compile and analyze patient, program and facility clinical and financial data in order to evaluate and improve patient outcomes, and maintain program viability.
  11. Coordinate and compile patient information in order to ensure that discharge arrangements are completed and facilitate the implementation of discharge recommendations. 
                (PEOPLE)
  1. Mentor, negotiate, instruct and speak with patients and families in order to orient them to the program services, admission and discharge criteria and patient/family responsibilities in order to ensure patient/family active participation in the program.
  2. Negotiate, instruct and speak with patients and families regarding financial information in order to maximize informed decision-making.
  3. Negotiate and speak with patients, families and other customers regarding concerns/grievances and facilitate resolution in order to ensure customer satisfaction.
  4. Negotiate, instruct and speak with patients and families regarding discharge/transition arrangements in order to maximize patient outcomes, and appropriate utilization of the continuum of care.
  5. Mentor, negotiate, instruct and speak with members of the interdisciplinary team in order to plan, implement, coordinate, monitor, evaluate and document the patient plan of care.
  6. Mentor, negotiate, instruct and speak with members of the interdisciplinary team in order to monitor and resolve issues related to the plan of care in order to maximize customer satisfaction, patient/family participation and efficient, effective care delivery.
  7. Negotiate, instruct and speak with interdisciplinary team and business staff regarding patientâ??s financial information in order to coordinate, monitor and evaluate appropriate program development, modification and efficient financial management.
  8. Negotiate, instruct and speak with internal and external physicians and other service providers regarding patientâ??s progress, needs and program goals in order to coordinate and evaluate the program to maximize patient outcomes and/or responsible utilization of resources.
  9. Negotiate, instruct and speak with third party payer representatives in order to develop contractual arrangements for services when necessary.
  10. Negotiate, instruct and speak with external case managers regarding patientâ??s clinical program in order to coordinate and evaluate the program, maximize patient outcomes, and appropriate utilization of resources.
  11. Negotiate, instruct and speak with interdisciplinary team and other stakeholders in order to ensure that discharge arrangements are complete and facilitate the implementation of discharge recommendations.
  12. Negotiate, instruct and speak with team members, patients and families, and other stakeholders to coordinate follow up in order to ensure customer satisfaction.
  13. Negotiate and speak with Case Management supervisor and/or the Director of Case Management and other appropriate staff regarding difficult case situations and/or interdisciplinary team difficulties in order to assess, monitor and evaluate quality service delivery.
  14. Instruct and speak with new department employees, team members, students and colleagues in order to recruit and retain a quality work force, and enhance the profession.
  15. Take instruction from the Case Management Supervisor, the Director of Case Management and/or the administrative personnel to perform other functions as assigned in order to achieve the goals within the department and Madonna as a whole.
  16. Negotiate with the Social Worker to ensure the primary Social Workâ??s functions are coordinated for continuity of care in the Social Worker's absence.
 
            (THINGS)
  1. Operate telephone, dictation equipment, photocopy machine, fax machine, personal computer and calculator in order to communicate with necessary internal and external people and agencies and to compile patient information.
  2. Maintain and assure a safe environment for the department.  Handle and operate all necessary equipment and perform required duties according to established safety standards to maintain compliance with regulations and prevent injury.
  3. Assist with ensuring cleanliness of equipment and environment.
 
 
PHYSICAL DEMANDS AND ENVIRONMENTAL CONDITIONS
 
Physical requirements:  Frequent sitting, standing and walking, occasionally lifting/carrying less than 10 pounds, frequently handling paper, pens, dictation equipment, telephone and personal computer.  Frequently talking and hearing ordinary tones for conversational speech in person and on the telephone, frequently seeing handwritten and printed and on-screen material.  Near vision acuity is required for reviewing medical records and documenting.
 
 
QUALIFICATIONS (Education/training and/or Experience)
 
Must be a Registered Nurse with current Nebraska RN licensure.  Must have a minimum of 2 years clinical experience, one of which must be in physical rehabilitation.  CCM preferred.  Experience in medical case management or team facilitation preferred.  General knowledge of Medicare and Medicaid programs and basic knowledge of indemnity and managed care insurance required.  Knowledge of general rehabilitation principles, community resources, and group dynamics required.  Must possess effective skills in negotiation, group facilitation, conflict management and consensus building.  Must possess well-developed written and verbal communication and problem solving skills.  Must possess and maintain current licensure/certification in area of clinical practice. 
 
Background checks are conducted.  When specific authorization forms are requested so that full background and history can be obtained, employees/applicants must sign the form(s) requested.
 
























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