POSITION STANDARDS Bachelor's degree in nursing required; Master's preferred. Licensed as a Registered Nurse in the State of New Hampshire. BCLS certification required within 30 days of hire. Board Certification in Case Management (CCM or CMC) preferred. If not certified, willingness to work toward CCM Certification in reasonable timeframe. Five years experience in a health care setting. Experience as a Case Manager is an asset. Excellent interpersonal skills required. Ability to build and maintain positive working relationships. Excellent written and verbal communication skills. Knowledge of Microsoft Office Suite preferred. Capable of prioritizing and completing a high volume of requests quickly and efficiently in multiple diverse environments with strong attention to detail. Ability to work effectively in a self directed role and make clear decisions. POSITION PHYSICAL REQUIREMENTS Anything listed here requires a pre-employment physical by Employee Health to determine if the employee is capable of meeting the requirements. Physical Activity: Light lifting up to 50 lbs. Upper Extremity: Walking, bending and sitting for extended periods of time. Push/Pull/Lift/Carry: PART TWO: FUNCTIONAL RESPONSIBILITY

 

Position Objective The Case Manager will spend time specific to the role of case management and utilization review: Lead a collaborative process with the members of the healthcare team to coordinate patient care and transitions. Promote a patient and family/caregiver centered approach to care coordination and transitions. Facilitate seamless lines connecting patients, providers and caregivers to community resources. Organize patient care activities to facilitate an effective and efficient use of healthcare resources.

 

Performance Expectation Coordinate the integration of social services/case management functions into the patient care, discharge, and transition planning processes with other hospital departments, external service organizations, agencies and healthcare facilities. Conduct concurrent medical record review using specific indicators and criteria as approved by the Department of Quality, Medical Staff, CMS and other state agencies. Performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery. Act as a resource to providers and staff for questions around payers. Promote effective and efficient utilization of health care services. Mobilizes resources to assist in achieving desired clinical outcomes within the desired time frame. Conducts review for appropriate utilization of services from admission through discharge. Evaluate patient satisfaction and quality of care provided as it relates to coordination of care and transitions. Initiates and presents “denial letters”, as appropriate. Assesses patient care required throughout continuum of care for diagnosis, procedures and DRG's. Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship. Assist physicians to maintain appropriate cost, case, and desired patient outcomes. Introduces self to patient and family and explains clinical case manager role and process for patient and family to contact clinical case manager. Complete expanded assessment of patients and family needs at time of admission. Complete psychosocial assessment. Assess patient's progress through expected hospital course. Refers cases where patients and/or family would benefit from psychosocial counseling to Social Services. Serve as a patient advocate. Enhances a collaborative relationship to maximize the patient's and family's ability to make informed decisions. Facilitates interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post-hospital needs. Collaborate with clinical staff in the development and execution of the plan of care, and achievement of goals. Coordinates the provision of social services to patients, families, and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services.