Care Manager II - Case Management
Christus Health
- Corpus Christi, TX
- Permanent
- Part-time
- The Pavilion and the Critical Care Center house a state-of-the-art Emergency Department, ICU, Cardiac Cath Lab and surgical suites.
- A teaching facility, in affiliation with the Texas A&M University System Health Science Center College of Medicine
- Accredited Chest Pain Center
- Accredited Joint Commission Stroke Team
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Coordinates the integration of case management functions into the patient care and discharge planning processes in collaboration with other hospital departments, external service organizations, agencies, and healthcare facilities.
- Coordinates/facilitates patient care progression throughout the continuum of care in an efficient and cost-effective manner.
- Serves as resource, provides support, and advocates on behalf of the patient related to treatment decisions and end of life issues.
- Closely monitor patient length of stay in regard to the geometric mean length of stay and communicate/collaborate with appropriate interdisciplinary team members to remove barriers and expedite discharge.
- Implements and monitors the patient's plan of care to ensure effectiveness and appropriateness of services.
- Identifies and escalates local and system barriers that are impeding diagnostic or treatment progress and issues related to quality and risk as appropriate in a timely manner.
- Proactively identifies and resolves delays and obstacles to discharge.
- Uses advanced conflict resolution skills as necessary to ensure timely resolution of issues.
- Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
- Interviews patients/families to obtain information about social, emotional, and financial factors which impact health status to develop comprehensive discharge planning assessment and care plan.
- Assesses needs for discharge planning and continuing care/resource support following discharge; independently makes recommendations to patients and families regarding post-acute level of care needs and options including:
- Acute Rehabilitation Placement
- Nursing Home or Skilled Nursing placement
- Psychiatric or Substance Abuse placement
- New Dialysis
- Child/Adult/Domestic Abuse
- Home Health/Hospice Referrals
- Legal issues (adoptions, guardianship)
- Assistance with Advance Directives
- Community Resource needs
- Financial Issues/Funding options
- DME Referrals and Coordination
- Social Determinants of Health
- Initiates discharge planning at the time of admission and makes post-hospital service referrals based upon information gathered during assessment and interactions with physicians, multidisciplinary care team, and payors as indicated.
- Acts as patient advocate by negotiating for, and coordinating, resources with payors, agencies, and vendors.
- Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
- Provide appropriate interventions which demonstrate knowledge of and sensitivity toward cultural diversity and the religious, developmental, health literacy, and educational backgrounds of the patient population.
- Assesses the patient's formal and informal support system as well as available benefits and/or community resources.
- Meets directly with patient/family to assess needs and develop and individualized care plan in collaboration with the physician.
- Ensures and maintains plan consensus from patient/family, physician and payor.
- Provides education, information, direction, and support related to patient's goals of care.
- Acts as patient advocate to develop treatment plan and coordinate patient care and to transition patient to the appropriate next level of care.
- Demonstrates and promotes respect for the dignity and rights of every patient while adhering to the safety standards and practices of the organization and the nursing profession.
- Collaborates with the physician and other health care professionals to promote appropriate use of medical center resources.
- Provides information and support to patients and families, helping them access needed resources within the medical center and community.
- Actively participates in clinical performance improvement activities involving length of stay, resource utilization, avoidable days, cost per case, and readmissions.
- Measures effectiveness of interventions through direct communication with post-acute care providers, patients, and caregivers.
- Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
- Actively participates in Multidisciplinary/Patient Care Progression Rounds.
- Escalates cases as appropriate and per policy to Physician Advisors and/or CM Director.
- Documents in the medical record per regulatory and department guidelines.
- May be asked to assist with special projects.
- May serve a preceptor or orienter to new associates.
- Assumes responsibility for professional growth and development.
- Must have excellent verbal and written communication and ability to interact with diverse populations.
- Must have critical and analytical thinking skills.
- Must have demonstrated clinical competency.
- Must have the ability to Multitask and to function in a stressful and fast paced environment.
- Must have working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
- Must have understanding of pre-acute and post-acute levels of care and community resources.
- Must have ability to work independently and exercise sound judgment in interactions with physicians, payors, patients and their families.
- Must be understanding of internal and external resources and knowledge of available community resources.
- Must have the ability to move around the hospital to all areas for the majority of the workday while in office the rest of the day; general office and hospital environment.
- Graduate of an accredited school of nursing (BSN preferred) or Masters Degree in Social Work (MSW) required or demonstrated success in CHRISTUS Care Manager I Position for at least 5 years on top of the required experience in lieu of education required.
- Two or more years clinical experience with one year in the acute care setting preferred.
- RN or LMSW in the state of employment is required for new hires.
- LBSW accepted for associates with 5+ years of demonstrated success and experience in CHRISTUS Care Manager I role.
- Certification in Case Management preferred.
- BLS preferred.