Oversees the utilization of healthcare resources, including discharge planning to facilitate the achievement of clinical, quality, financial and patient satisfaction goals.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Performs admission and concurrent review to identify medical necessity, level of care and appropriateness of setting using
established criteria and clinical guidelines within 24 hours of admission (excluding weekends/holidays).
Reviews the admission assessment, collaborates with primary nurse and other health care providers to ensure a multidisciplinary
plan-of-care is in place to meet identified patient care needs and desired outcomes.
Identifies system issues that serve as barriers to care. Participates in development and implementation of strategies to remove
barriers and facilitate performance improvement measures.
Monitors efficiencies in scheduling diagnostic procedures and coordination of treatments to facilitate achievement of effective
clinical, fiscal, quality and patient satisfaction goals.
Participates in multi-disciplinary team rounds on the assigned unit.
Collaborates with the unit medical director and/or physician advisor to facilitate achievement of clinical, quality, financial and patient
Notifies the Physician Advisor when patient does not meet criteria for acute care hospitalization, pursues documentation to justify
continued stay with in 24 hours.
Presents MOON forms, Discharge IMM letter, Detailed Notice of Discharge Letter, Letter of non-coverage to patients and/or families
Communicates and secures continued stay authorization with Managed Care Organizations.
Serves as a resource to nursing and ancillary staff, providing education on utilization review processes as needed.
Trends potential barriers to patient advancement through the system, intervenes assertively and appropriately when necessary.
Identifies need for patient to be evaluated by other members of the health care team and takes appropriate action to facilitate.
Identifies patients who have post-acute care, placement, and complex discharge planning needs based on a comprehensive assessment that includes physical, as well as psycho-social factors/needs.
Anticipates, initiates, and establishes a discharge plan for patients with post acute care needs, collaborating with the physician, nurse and other health care providers, the patient, their family/primary caregiver(s), third-party payers, and employer in accordance with established clinical guidelines, standards, and pathways.
Communicates patient needs and arranges services with appropriate resources after securing patient consent and choice of vendor. Takes ownership of the discharge process to expeditiously return the patient to the most appropriate post-acute care setting. Establishes time specific objectives, goals, and actions in conjunction with the patient and family, to meet identified needs. Builds trusting relationships with internal and external customers, i.e., physicians, nurses, patients and their families, vendors, payers, etc.
Organizes, secures, monitors, and modifies the resources necessary to meet the goals stated in the case management plan. The Case Manager confirms the continuation of patient care services across the continuum via phone follow-up with patients/family to ensure the discharge plan has been executed.
Alerts social work of all patients with potential placement needs and works to facilitate the provision of care in the most appropriate care setting.
Serves an an expert consultant to members of the health care team and works closely with assigned units to meet LOS expectations. Manages and accurately documents pertinent patient and case management data in Meditech CM Module. Updates plan of care every 48 hours
Assumes responsibility for professional growth, shares knowledge with co-workers and health care team members.
Performs assigned work safely, adhering to established departmental safety rules and practices; reports to supervisor, in a timely manner, and unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients or visitors.
Performs other related duties as required
Reviews patients' progress with members of the health care team. Monitors use of clinical pathways, verifying appropriate use and progress toward identified patient care outcomes. Monitors compliance with National Patient Safety Goals within assigned unit. Participates in monthly unit-based PI meetings to improve compliance with National Patient Safety Goals and JCAHO on-going readiness efforts. Assists with data collection and implementation of action plans for CMS, JCAHO, AHA Quality Initiatives as well as CCHS defined measures.
Communicates to Nurse Manager/Nursing staff, data collection results and directs change needed to come into compliance. Collaborates with performance improvement to identify opportunities, recommend selections, and support PI initiatives to improve outcomes on assigned units.
Demonstrates on-going commitment to the department by serving as a preceptor, providing in-service and/or educational presentations annually, and participating in unit-based PI initiatives to include organizational and regulatory monitors and/or measurements. Actively participates in department operational planning work groups.
Demonstrates commitment and leadership in specialty through membership in professional organizations such as ACMA
EDUCATION AND EXPERIENCE REQUIREMENTS:
Registered Nurse with related work experience in Utilization Management, Case Management and or Home Care preferred. . Some continuing education should be related to role enhancement and changes of clinical practice within assigned area.
KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS:
Strong interpersonal skills relative to both professional and lay interactions. Strong organizational skills.
Working knowledge of Performance Improvement activities. Working knowledge of data management/reporting practices
Active MD RN Licensure, in good standing.
EEO Statement: Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.
UPDATE: ChristianaCare is committed to prioritizing the health and safety of our patients and caregivers. As we continue to meet the needs of our caregivers and our community through the COVID-19 pandemic, our commitment to health and safety requires that we take new steps to ensure a safe environment for medical care for our patients and a workplace that avoids preventable harm for our caregivers. For this reason, vaccination for COVID-19 is required for all caregivers at ChristianaCare and is considered a safety standard that is job-related and consistent with business necessity for all caregivers.
ChristianaCare Health System is headquartered in Wilmington, Delaware and is one of the country's largest health care providers, ranking 21st in the nation for hospital admissions. Christiana Care is proudly a Nurse Magnet recognized institution. Christiana Care Health System is also one of the largest health care providers in the mid-Atlantic region, serving all of Delaware and portions of seven counties bordering the state in Pennsylvania, Maryland and New Jersey. A not-for-profit, non-sectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, and is a major teaching hospital with two campuses. Christiana Care is continually recognized for excellence on a regional and national level. Our role in the community is expressed in the Christiana Care Way: "We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value."Christiana Care is a great place to work because we value diversity and recognize it to be a core part of our success. Because of the diversity of our employees, affiliated health professionals and volunteers, we are ...positioned to meet the unique needs of our patients and community. We acknowledge and celebrate the uniqueness and talent of each employee. Because of our talented workforce we are able to provide a quality healthcare experience to our patients and community. We strive to create an inclusive environment in which individual diversity can be leveraged and thrive. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.