Job Requisition: REQ2686

Employment Type: Full time; Float position

Shift: Days

Hours Per Week: 40 hrs

Hiring range: $33.50- $44.66

The actual compensation for this position will be determined based on experience and other factors permitted by law.

Responsibilities:

Participates in the referral process by assessing patient/family needs, communicating needs to multidisciplinary team, and reporting recommendations back to referral source. Collaborates with any other case managers working with a patient/family from payer, community agencies, etc. to ensure continuity of care and to avoid duplication of services. Collaborates with the interdisciplinary inpatient team for discharge planning needs, transition of care.

Utilizes case management process by: o assessing patient/family needs in hospital post-acute, home, or other community location. Identify risk factors and specialized care planning required. o establishing and implementing a plan to proactively facilitate achievement of outcomes through communication with patient/family, safe transition of care and health care team to coordinate care.

Ongoing planning to achieve individualized patient/family outcomes.

Evaluating patient/family outcomes to continuously update the plan, coordinate appointments to PCP and Specialists and ongoing call backs to achieve targets.

Documenting plan and interventions

Advocates for patient/family within the health care system and community. Supports the family to become active participants in the health care of the patient with the goal of the patient/family providing their own care coordination whenever possible.

Initiates community resource referrals as needed. Provides appropriate linkages, referral coordination, transportation arrangements, and follow up for identified patients with home care, health home, social determinants of health and other transitions of care needs.

Follows necessary documentation for billing public and private funding sources.

Assesses patients for the need for medical care coordination – working daily with provider and team.

Focuses coordination of care on maximizing a patient/family’s available resources (both financial and social/emotional). Strives for care to be provided in a quality, cost-effective context.

Provides hand off communications to PCP/Specialist’s care manager to discuss care planning and goals. Multidisciplinary communication, collaboration, and coordination, including patient/care giver education from admission through discharge.

• Education: Degree in Nursing (RN) required. BSN preferred. Knowledge of complex chronic adult patients. Experience in case management preferred. Requires a working knowledge of families within community systems and application to case management practice
• Certifications / Licensure: A current license to practice professional nursing in the state of New York. Certification as a Case Manager desired.

• Skills & Attributes: Ability to organize and establish day-to-day priorities while using critical thinking skills in all aspects of the job.  Must be able to multitask while remaining professional, focused, composed and positive.  Excellent customer service skills  Displays integrity, friendliness, and compassion.  Must be able to establish an appropriate and effective rapport with others.  Demonstrates flexibility  Takes initiative  Able to work in a fast-paced environment  Embraces new opportunities to grow both personally and professionally.  Effective critical thinking and problem-solving skills.  Proficient with various Microsoft Office products (Word and Excel).  Strong organizational skills.  Effective interpersonal skills.  Ability to take and follow direction in a positive and appropriate manner.  Ability to work as part of a team and independently. Must be able to demonstrate effective and appropriate written and oral communication skills.  Must be able to speak, read, write and follow instructions in English.

  Complexity of Work:
  

  • Within scope of job, requires critical thinking skills, decisive judgment and the ability to work with minimal

  supervision. Must be able to work in a stressful environment.
  Personal Protective Equipment:
  

  • Follows Standard Precautions using personal protective equipment as required.