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RN CASE MANAGER


Job Type: Full-time
Location: Natchitoches Regional Medical Center
Department: LOUISIANA EXTENDED CARE


Description:

Primary Responsibilities

1. Receives referrals and ensures appropriate RN and/or therapy case manager and assignments and timely initial patient evaluation visits and ongoing services as required.

2. Coordinates and supervises activities and collaborates with Stroke Central to manage work volume, caseloads, productivity, and caregiver optimization of team as appropriate, and to ensure services are compliant with the goals of the Stroke Innovation Program, as well as state and federal laws, rules, and regulations governing care and practice.

3. Assists in developing, initiating, and coordinating the plan of care, individualized for the family, through the identification of family members who are at risk for stroke and assisting in development of novel methods to promote change in the family unit. 

4. Assist in contacting of community services and provides ongoing assessments to evaluate progress towards identified goals. 

5. Provides patient care as ordered by the physician and facilitates exchange of information through Stroke Central. 

6. Assess progress towards target goals for depression, physical function, fall risk, BP, lipids, and diabetes each visit. 

7. Directs case conference and facilitates exchange of information across disciplines in coordination with Stroke Central to attain goals set for Stroke Innovation Program. 

8. Assists in coordinating appointments and transfers as indicated by Stroke Central.

9. Reviews at least three clinical notes per week and ensures timely, complete, appropriate, and accurate submission of all documentation in EPIC.

10. Oversees service delivery to ensure appropriateness of teaching plans and methods and progress towards goal by medical record reviews and care conferences. 

11. Provides ongoing support and education on issues related to stroke, risk factors related to prevention of stroke for the patient. 

12. Assists in developing novel approaches, involving the family unit which will decrease the risk of stroke for all family members. 

13. Provides direction, counsel, and leadership under the direction of the Branch Manager and Stroke Central. 

14. Participates in the overall performance improvement plan, program, and process. 

15. Assists in formulation, revision, implementation, and evaluation of the Stroke Innovation Program goals delineated in the Driver Diagram for the Stroke Innovation Program.

16. Provides care to the patient each visit as determined in the program and assess progress toward goals each visit. 

17. Documents assessments, nursing care, lab results, educational activities, and coordination with Stroke Central in EPIC at each visit.

18. Identifies areas of deviation from progress towards goals with Stroke Central and makes revisions in plan in coordination with Stroke Central.

19. Manages care, family care, and notifies Stroke Central of issues as delineated in Stroke Innovation Program.

20. Manages appointment schedule with family and calls before visit to verify upcoming appointments. 

21. Participates in education programs on stroke, identification of risk factors and prevention when available from Stroke Central. 

22. Provides care to family unit in accordance to the guidelines delineated in the Stroke Innovation Program visit document and notifies Stroke Central of any issues that could affect patient and family safety.

23. Participates in interviews, recommendations for hiring, and trains additional members of the Stroke Mobile Team.

24. Provides oversight and direction to other members of the Stroke Mobile Team, including Rehabilitation RNs and Rehabilitation Educators. 

25. Facilitates communication between Stroke Central and Stroke Mobile.

26. Promotes effective and efficient utilization of clinical resources.

27. Mobilizes resources and intervenes as necessary to achieve expected goals and achieve desired clinical outcomes within the desired time frame.

28. Monitors that patient tests are appropriate and necessary and are carried out within the established time frame and that results are promptly available.

29. Conducts review for appropriate utilization of services from admission through discharge, evaluates patient satisfaction, and evaluates quality of care provided in conjunction with Social Services.

30. Performs reviews for third party payors as appropriate. 

31. Initiates and issues “adverse determination letters” as appropriate. 

32. Addresses patient care required throughout continuum of care for diagnosis, procedures, and DRGs.

33. Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship. Assists physicians to maintain appropriate cost/case and desired patient outcomes.

34. Conducts job responsibilities in accordance with the standards set out in the company’s Code of Business.

35. Conducts company’s policies and procedures, the Corporate Compliance Agreement, federal and state laws, and applicable professional standards. 

36. Introduces self to patient and family and explains case manager role and process for patient and family.

37. Assesses patient’s progress through expected hospital course.

38. Refers cases where patients and/or family would benefit from additional resources support to the Social Worker.

39. Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions.

40. Participates in interdisciplinary patient care rounds and family conference to review treatment goals, optimize resource utilization, provide family education, and identify post hospital needs.

41. During Team Conferences directs the interdisciplinary staff in the development and execution of the plan of care, and achievement of goals. 

42. Participates in the development and implementation of patient care policies and protocols in order to provide advice and guidance in handling special cases or patient needs.

43. 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 health care services. 

44. Initiates patient and family education and discharge planning upon admission.

45.  Arranges for discharge and post-hospital care of patients through institutions and agencies within the community. 

46. Participates with physicians, nursing personnel, and other members of the management team in the planning of patient care services and the patient care plan.

47. Creates appropriate discharge plans and documents information in the medical record. 

48. Assists in identifying opportunities for improvement, participates in data collection analysis, contributes to problem solving and identification of actions to be taken and effectiveness of those actions. 

49. Develops an understanding of responsibilities for participation in PI activities. Participates in PI teams as requested. 

50. Assists in the development and implementation of best practices to optimize resource management to achieve desired outcomes. 

51. Prepares statistical reports on department services and patient needs; participates in the billing procedures for services rendered as required. 

52. Provides education and support to clinical staff by attending staff meetings, small groups, and one-on-one education related to resource utilization, discharge planning, and psychosocial aspects of healthcare delivery. 

53. Clinical Documentation Specialist TS: Obtains and promotes appropriate clinical documentation through extensive interaction with physicians, nursing staff, other patient caregivers, and coding staff to ensure that the documentation of the level of service rendered to the patient and the patient’s clinical complexity is complete and accurate.

54. Clinical Documentation Specialist TS: Reviews medical records and identifies potential gaps in clinical documentation for specified patients’ types and payor populations as directed on admission and throughout hospitalization. 

55. Clinical Documentation Specialist TS: Participates in the analysis and trending of statistical data for specified patient populations to identify opportunities for improvement. 

56. Clinical Documentation Specialist TS: Queries physicians and other caregivers as necessary via approved written communication mechanisms to obtain accurate and complete documentation that supports the severity of patient illness, intensity of services, and risk of mortality. 

57. Clinical Documentation Specialist TS: Completes concurrent review on assigned population of patients. 

58. Clinical Documentation Specialist TS: Works closely with coding staff to assure documentation of discharge diagnoses and any co-existing comorbidities or complications to completely reflect the patient’s clinical status and care.

59. Clinical Documentation Specialist TS: Demonstrates basic knowledge of coding standards and application to ongoing evaluation of medical record documentation.

60. Clinical Documentation Specialist TS: Develops and implements plans for both formal and informal education of physicians, nursing, and other clinical staff.

61. Clinical Documentation Specialist TS: Assists with preparation and presentation of clinical documentation, monitoring trending reports for review with physicians and hospital leadership. 

62. Clinical Documentation Specialist TS: Identifies strategies through data gathering and analysis of trends to establish recommendations for sustained work process changes that facilitate complete, accurate clinical documentation. 

63. Clinical Documentation Specialist TS: Assists in the appeal process resulting from third-party reviews. 

64. Clinical Documentation Specialist TS: Consistently meets established productivity targets for record review. 

Competencies

1. Leadership.

2. Collaboration Skills.

3. Customer/ Client Focus.

4. Problem Solving/ Analysis.

5. Time Management.

6. Computer Literacy.

7. Ability to communicate effectively both verbally and in writing. 

Requirements:

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