JOB DESCRIPTION

JOB TITLE: Weekend Case Manager

DEPARTMENT: Case Management

JOB GRADE/CODE: XEM 8

REPORTS TO: Director of Case Management

SUPERVISES: N/A

SCOPE OF POSITION:

Under the general supervision of the Director, weekend RN Case Manager will act as gatekeeper for admissions by assessing for appropriateness of admissions and capturing accurate levels of care on admission. Provides initial validation and intake assessment on patients being admitted. Accepts report hand-off from weekday team members and follows up as needed to ensure safe/timely discharge plan.

RESPONSIBILITIES:

• Follows CM processes to determine and guide doctors on appropriate admissions and levels of care.
• Assesses for the appropriateness of diagnostic testing, procedures, and consults based on medical necessity. Discusses alternative options with providers if not medically appropriate for inpatient or observation level of care.
• Comfortable with EMR charting system - Allscripts.
• Communicates and coordinates with the health care team to intervene when progression is stalled or diverted.
• Follows up and completes the interventions necessary for discharges to home with self-care, home with services and short-term skilled nursing facility placement. Assembles necessary referrals, discharge summaries and pertinent information for placement prior to the day of discharge.
• Provides support and effective communication with inter and intra-department team members
• Validates admission and continuing stay criteria with third party payers (including onsite and telephonic Case Managers) as well as Primary Care and Attending Physicians. Recommends alternative care sites where appropriate.
• Collaborates with the third-party payers to anticipate denial of payment and proactively addresses issues contributing to a potential denial. Intervenes to prevent the denial where possible.
• Supports the effective prevention and management of denials, including drafting appeal letters and/or providing information as part of the appeal process.
• Assesses the patient and family for continuing care needs to develop, implement and evaluate an effective discharge plan in collaboration with the multidisciplinary team. Uses knowledge of usual length of stay to initiate a plan for discharge.
• Collaborates and communicates with patients/families related to reimbursement issues and to create a discharge plan. Supports the process of patient choice in establishing a discharge plan.
• Identifies high risk patients and creates a collaborative plan to address their unique needs.
• Key stake holder in the patient throughput process, supports safe and expeditious transition of patients.
• Performs all other duties as assigned.

REQUIREMENTS:

• Licensed as a Registered Nurse in the State of Connecticut.
• Graduate nursing program (Diploma/Associates) BSN preferred or actively working towards BSN. Bachelor’s Degree in Nursing or a related field.
• 2 – 3 years’ experience in case management, discharge planning, and/or progression of care in the acute-care setting preferred

COMPETENCIES:

• Ability to problem-solve in a proactive, creative manner using sound judgment based on factual information and clinical knowledge.
• Communicate in a clear, concise, and logical manner in oral and written presentations.
• Strong interpersonal, communication, and negotiation skills.
• Ability to form positive, collaborative relationships with hospital staff, patients and families.
• Ability to effectively negotiate with internal and external providers of patient care services.
• Analytical abilities to assist in obtaining solutions to problems.
• Able to work independently and prioritize work.
• Able to manage multiple priorities.
• Basic knowledge of computers and clinical applications.
• Basic knowledge of Microsoft Office, including Excel and PowerPoint
• Must complete all Waterbury Hospital mandated trainings, safety and compliance assignments

• Must have strong computer skills and the ability to access internet and other programs applicable to Waterbury Hospital procedures.
• Perform automated functions that fall within job responsibility.