Nurse Case Manager
Company: Albany Medical Center
Location: Albany
Posted on: April 17, 2024
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Job Description:
Department/Unit:Care Management/Social WorkWork Shift:Day
(United States of America)The Case Manager is accountable to
facilitate the interdisciplinary team to plan, coordinate,
implement and evaluate patient care for assigned service line
across the continuum of care. The Case Manager works proactively
with the Quality Improvement Teams, patient care standards, Social
Work, and utilization management to coordinate the appropriate use
of resources to achieve maximum clinical and financial
outcomes.Salary Range: $65,057.00 - $107,348.80The Case Manager
participates in maintaining quality care and performance
improvement through leadership, problem solving, decision making,
and outcome measurement. The Case Manager functions as a resource
for the health care team, community, patient/significant
others/family and payers by functioning as a clinician, consultant,
advocate and educator for assigned service.The Case Manager
participates in maintaining quality care and performance
improvement through leadership, problem solving, decision making,
and outcome measurement. The Case Manager functions as a resource
for the health care team, community, patient/significant
others/family and payers by functioning as a clinician, consultant,
advocate and educator for assigned service.Principal Position
Responsibilities1. Coordination of Carea. Assists the admission MD
and or designated physician and the interdisciplinary teams in
assuring coordination of care across the continuum of care in the
hospital pre and post-op.b. Proactively monitor patients' clinical
process through /patient care standards and evidence-based
guidelines to ensure timely, appropriate interventions that achieve
optimal patient outcomes within appropriate LOS and financial
constraints.c. Provides collaborative care management with the
primary nurse in assessing for discharge planning needs,
coordinating appropriate resources and evaluating effectiveness of
the discharge plan. The discharge planning process needs to begin
on admission.d. Collaborates with the health care team and
appropriate department in the management of care across the
continuum of care, including pre-admission, discharge,
post-discharge, planning length of stay, and utilization of
resources.e. Utilizes own special body of knowledge and evidence
based guidelines to provide leadership and guidance to the health
care team in formulating an individualized multidisciplinary plan
of care to include: pre hospitalization, acute hospital care,
discharge education, transition to home and use of community
resources.f. Facilitates and participates in health care team care
conference for patients with complex problems.g. Facilitates
patient and family education and the discharge process to promote
continuity of care and optimal patient outcomes.h. Demonstrates
experience in the referral process and use of community
resources.2. Utilization Reviewa. Reviews data from admission
screening to clarify admission diagnosis, establish appropriate
length of stay, and identify any potential outliers and determine
appropriateness of admission based on institutional standards and
evidence based guidelines.b. Contacts payer source to
confirm/negotiate benefits and provide concurrent reviews.c.
Identifies capitated patients to determine appropriate utilization
of series and coordinates post hospital care using defined
standards.d. Identifies high-risk patients based on clinical and
financial criteria for collaboration with patient financial
services to problem-solve available resources.e. Ensures that
appropriate medical/legal documentation is contained in patient's
records.f. Complies with regulations established by third party
payers including but not limited to notices of non-coverage
reinstatement and continued stay.g. Follows department UM
guidelines.3. Quality Improvement a. Collaborates with the health
care team in implementing strategies to reduce length of
stay/resource consumption to optimize patient health status for an
assigned service patient.b. Assesses educational needs and provides
learning opportunities for health care professionals relevant to
particular cases and selected patient care groups.c. Demonstrates
creativity and critical thinking ability in the development of
programs or projects.d. Works with quality improvement team for
continuous improvement of patient care outcomes while increasing
quality and decreasing cost.e. Ensure that communication and
transmission of documentation occurs with community agencies.4.
Measurement a. Collaborates with case management leadership to
compile and report aggregate variances and data for specific
patient care services.b. Communicates and analyzes aggregate
variances with members of the health care team and develops
strategies for variance reduction.Qualifications and Ideal
Characteristics 1. Registered nurse with a current license.2.
Associate's degree required. BS or MS preferred.3. Minimum of three
years clinical experience in an assigned service. Acute care
nursing experience preferred.4. Recent experience in case
management, utilization management and/or discharge planning/home
care in a high volume, acute care hospital preferred. PRI and Case
Management certification preferred.5. Demonstrates effective
communication, facilitation, and organizational skills.6. Assertive
and creative in problem solving, critical thinking skills, systems
planning and patient care management.7. Self-directed with the
ability to adapt in a changing environment.8. Basic knowledge of
computer systems with skills applicable to utilization review
process.Mission, Core Values and Service Excellence 1. Contributes
to the creation of a compassionate and caring environment for
patients, families, and colleagues through displays of kindness and
active listening. Recognizes and appreciates that each employee's
work is valuable and contributes to the success of the Mission.2.
Demonstrates excellence in daily work. Willing to actively
participate in performance and quality improvement activities and
to work towards enhancing customer/patient satisfaction.3. Exhibits
positive service excellence skills to patients, visitors, and
coworkers by greeting others in a friendly manner, keeping
customers/patients/colleagues informed about progress, delays, and
changes.4. Demonstrates effective teamwork by interacting in a
positive manner with colleagues and creating a collaborative work
environment. Initiates open communication, conveys positive intent,
offers assistance.5. Contributes to a safe and secure environment
for patients, visitors, colleagues by following established
procedures and protocols.6. Demonstrates stewardship by thoughtful
and responsible use of resources including maintaining a clean and
hospitable environment, starting work on time, displaying a
consciousness regarding costs, supplies and department finances.7.
Demonstrates respect for individual differences of each person by
acknowledging the essence of each person, appreciating, and
responding to unique, spiritual, personal, and cultural backgrounds
of patients, families, and colleagues.Physical DemandsThe physical
demands described here are representative of those that must be met
by an employee to successfully perform the essential functions of
this job.While performing the duties of this job, the employee is
regularly required to stand, walk, use hands to probe, handle, or
feel objects, tools, or controls, reach with hands and arms, and
speak and hear.The employee is occasionally required to sit and
stoop, kneel, or crouch.The employee must regularly lift and/or
move up to 50 pounds. Specific vision abilities required by this
job include close vision, distance vision, peripheral vision, depth
perception, and the ability to adjust focus.Work Environment The
work environment characteristics described here are representative
of those an employee encounters while performing the essential
functions of this job. While performing the duties of this job, the
employee may be subject to infectious materials and chemicals (see
unit specific MSDS information).The noise level in the work
environment is usually moderate.This job requires as an essential
function that the majority of the time the employee be physically
on-site as the work cannot be done from a remote location.Other
RequirementsAll job requirements listed indicate the minimum level
of knowledge, skills, and/or ability deemed necessary to perform
the job proficiently. This job description is not to be construed
as an exhaustive statement of duties, responsibilities, or
requirements. Employees will be required to perform any other
job-related instructions given by their supervisor subject to
reasonable accommodation.Thank you for your interest in Albany
Medical Center!---Albany Medical is an equal opportunity
employer.This role may require access to information considered
sensitive to Albany Medical Center, its patients, affiliates, and
partners, including but not limited to HIPAA Protected Health
Information and other information regulated by Federal and New York
State statutes. Workforce members are expected to ensure
that:Access to information is based on a "need to know" and is the
minimum necessary to properly perform assigned duties. Use or
disclosure shall not exceed the minimum amount of information
needed to accomplish an intended purpose. Reasonable efforts,
consistent with Albany Med Center policies and standards, shall be
made to ensure that information is adequately protected from
unauthorized access and modification.
Keywords: Albany Medical Center, Albany , Nurse Case Manager, Healthcare , Albany, New York
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