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Case Manager - Case Management
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Job Code:
00018213
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Location:
Hackensack, NJ
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QUALITY SERVICE SAFETY
We're Nursing at its Best.
The very factors that drive Hackensack University Medical Center to national success are the same ones that drive America's best nurses to us. Nurses who value quality, service, and safety. Nurses who are invigorated by patient care and cutting-edge medicine. Who are energized by career advancement. Who know that the Magnet Award for Nursing Excellence is more than an honor, it's a way of thinking.
Knowledge, Education and Skills Required:
• B.S.N.
• Excellent interpersonal communication and negotiation skills.
• Strong analytical, data management and PC skills.
• Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources.
• Strong organizational and time management skills, as evidenced by a capacity to prioritize multiple tasks and role components.
• Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
• Commitment required to work every other weekend.
• Commitment to rotate to evenings as required.
Knowledge, Education and Skills Preferred:
• R.N. with at least 5-year’s clinical experience in the relevant clinical specialty (e.g., care managers for pediatric patients should have pediatric nursing experience) with a minimum of 2 of the 5 years in Case Management in an acute care setting.
Required Certification/Licensing:
• Case Management certification
• Current and valid NJ State Professional Registered Nurse license
• Maintains American Heart Association Basic Life Support HCP certification
Job Summary:
The individual in this position bears overall responsibility for coordinating patient care activities to ensure that care meets evidence-based practice standards, and regulatory/payer requirements. The role integrates and coordinates utilization management, care coordination, and discharge planning functions. Case Managers may work in inpatient units, ETD, Capacity Management (patient access), PACU or in any other area of HUMC as deemed appropriate by the leadership of the department.
The Case Manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include:
• facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement
• facilitation of pre-certification and payer authorization processes
• application of process improvement methodologies in evaluating outcomes of care
• coordination of communication with physicians, nursing, and staff of ancillary departments
• evaluation of care provided against the GMLOS
• collaboration with Admitting to ensure accuracy of patient demographic and insurance information
• communication with patients and their families around medical plan of care and discharge plan
• assessment and plan for discharge needs and arrangements, including leading multi-disciplinary care conferences and discharge planning teams
Essential Generic Job Functions:
1) Coordinates/facilitates patient care progression throughout the continuum.
a) Works collaboratively and maintains active communication with physicians, nursing, and other members of the multidisciplinary care team to effect timely and appropriate patient management.
b) Identifies and resolves delays and obstacles to discharge in a proactive manner. Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
c) Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
d) Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
e) Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated caseload; monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis:
i) communication of all elements critical to the plan of care to the patient/family and members of the health care team
ii) completion and reporting of diagnostic testing
iii) completion of treatment plan and discharge plan
iv) modification of plan of care, as necessary, to meet the ongoing needs of the patient
v) communication to third-party payers and other relevant information to the care team
vi) assignment of appropriate levels of care
vii) completion of all required documentation in SoftMed screens, and patient records
PART TIME DAYS
EVERY OTHER WEEKEND
Join us by visiting humc.com and applying online.
HACKENSACK UNIVERSITY MEDICAL CENTER
When You Feel Good, We Feel Good.
We are an equal opportunity employer offering a smoke free environment.
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