Case Manager - RN (MD Anderson)
The primary purpose of the Case Manager position is to:
Develop an individualized plan of care by assessing, planning, facilitating and advocating for healthcare needs along the continuum of care to achieve optimal clinical, financial and operational outcomes. Coordinates with the Multidisciplinary Care Team and internal/external customers in the management of patient care. The role integrates and coordinates utilization management concepts, care facilitations, and discharge planning functions.
Standards of Practice - Care Coordination
• Serves as the liaison between internal and external team members regarding issues related to utilization management and /or coordination of care
• Facilitates the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement
• Identify payer related issues that may impact the continuity of care such as those patients with out of network insurance or those who may be underinsured
• Demonstrates ability to work independently and exercise sound judgment in interactions with physicians, members of the interdisciplinary team, internal and external customers, patients and their families
• Demonstrates excellent interpersonal communication and negotiation skills
• Demonstrates strong organizational and time management skills as evidenced by ability to prioritize and manage multiple tasks and role components
• Seeks consultation from appropriate disciplines as requested to expedite patient care and facilitate discharge
Modifies patient plan of care and documents as required to meet the ongoing needs of the patient
• Communicates plan of care to the patient/family and members of interdisciplinary team and documents to assure continuity of care
• Works collaboratively and maintains communication with physicians, nursing and other members of the interdisciplinary team to demonstrate effective, timely and appropriate patient care management and eliminate barriers to efficient delivery of care in the appropriate setting
• Responds to all consults in a timely manner
• Adheres to all departmental guidelines and polices that surround care coordination
• Work collaboratively with providers and medical team to ensure adequate documentation to support medical necessity of inpatient stay and level of care determinations
• The Case Manager is responsible for the oversight of Continuum of Care Planning for post hospital acute care services, including but not limited to, completion and facilitation of referrals and or transfers.
• Participates in and /or conducts daily inpatient rounds with members of the Interdisciplinary team of assigned units and twice a week in assigned outpatient clinics.
• Maintains visibility on assigned units and interacts with Clinical Care Team, patients and families
• Meets and discusses all assigned patients daily with Clinical Nurse Leader or designee
• Participates daily in multidisciplinary inpatient rounds with physician and/or designee
• Issues second IM Notice, Moon Notice, and Condition Code 44 notification and documents in OneConnect prior to discharge, as appropriate
• Responds to Patient Needs Assessment, documents interventions, and clears from list within one business day
• Responds timely to requests to coordinate discharge services for unplanned discharges
• Communicates, both verbally and in writing, all Case Management interventions regarding discharge plan
• Maintains knowledge of available post-acute care services based on payer coverage guidelines
• Completes ACMA Compass training annually
Documents daily Case Management activities appropriately in EPIC to reflect interventions prior to the close of business day
Documents all discharge planning activities in EPIC as needed or at a minimum weekly to include identified case management issues and progress towards discharge
Utilizes handoff tools in EPIC
Activates out of office notification on e-mail and voice mail with appropriate information prior to scheduled day off
Signs in as Case Manager on all assigned patients
Demonstrates compliance with all state and federal regulatory requirements
Facilitates authorizations for Rehabilitation transfers and ensures the preadmission Rehabilitation MCG (Milliman) review is completed prior to transfer to the Inpatient Rehabilitation Service.
Documents in EPIC the discharge care coordination information including name of agency with contact number, services to be provided and date and time services to start if applicable, i.e. I.V. antibiotics
Other duties as assigned
Education Required: Associate's degree in nursing (ADN).
Experience Required: Three years of experience as a Registered Nurse coordinating care for high risk and complex patients.
Licensure Required: Current State of Texas Professional Nursing License (RN). American Heart Association Basic Life Support (BLS).
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html
- Requisition ID: 157522
- Employment Status: Full-Time
- Employee Status: Regular
- Work Week: Day/Evening, Weekends
- Minimum Salary: US Dollar (USD) 91,000
- Midpoint Salary: US Dollar (USD) 113,500
- Maximum Salary : US Dollar (USD) 136,000
- FLSA: exempt and eligible for overtime, paid at a straight rate
- Fund Type: Hard
- Work Location: Onsite
- Pivotal Position: No
- Referral Bonus Available?: No
- Relocation Assistance Available?: No
- Science Jobs: No
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