Nurse Case Manager

Brown Health Medical Group • North Dartmouth, MA • 3w ago

SUMMARY: 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: KEY RESPONSIBILITIES: Coordinates patient care across
the continuum of care: As needed, strives to maximize and mobilize all
internal and external resources that facilitate the case management
process for all assigned cases Documentation always reflects patient
plan of past hospital care and if applicable interdisciplinary
coordination As needed, provides a nursing assessment within 24-48 hours
of patient admission for clinically oriented services focused on
mobilizing primary care physician, 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. Suggested interventions, expedited
interdisciplinary referrals and ensured diagnostic testing is completed
and reported within appropriate timeframe 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. 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. Community health care
agencies and third party payor utilization review agencies are provided
with patient care information through allscripts that is concise,
accurate and communicated in a timely manner. All reviews assigned to
per diem case manager sent when completed unless review referred for
second level review. Monitors utilization of resources: Exercises
professional authority intervening 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 Always demonstrates awareness of over or under
utilization of resources and responds accordingly Appropriately monitors
utilization of resources for caseload assigned Demonstrates
understanding and has accurately applied severity of illnessntensity of
service criteria according to third party payor guidelines,
appropriately identifying levels of care for all assigned cases.
Maintains ongoing dialogue with medical staff, nursing and other
involved therapeutic disciplines relative to utilization and length of
stay issues and communicates via Allscripts to unit case manager
Demonstrates initiative in exploring strategies to reduce length of stay
and resource consumption within complex case managed patient
populations. Effectively identifies patients for complex management
versus those patients with less significant needs care

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