Case Manager, RN

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The UHealth System at the University of Miami has an exciting opportunity for a Case Manager RN in the Population Health Department.

SUMMARY

The Case Manager RN coordinates the overall interdisciplinary plan of care for patients, from admission to discharge. Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers. Evaluates the needs of the patient, the resources available, and recommends and facilitates the plan for the best outcome. Develops a discharge plan that provides the best available resources to meet ongoing patient needs and that encourages compliance with medical advice. Identifies patient care issues and suggests revisions to or new clinical pathways to improve quality of care.

CORE JOB FUNCTIONS                                                                                                          

• Identifies the patients’ risk factors or obstacles to care, and discharge and readmission risk.

• Evaluates the plan of care regularly by chart review and patient interviews, as well as collaborates with the medical team to facilitate the patients’ movement through the system

• Educates patients and families on the progression of care.

• Serves as a liaison between patients, families, and healthcare personnel to ensure necessary care is provided promptly, effectively, and in a fiscally responsible manner.

• Promotes quality care to ensure patients receive medically appropriate services in appropriate status and stay standards.

• Facilitates ongoing insurance authorization for continued stay.

• Facilitates regulatory notifications and patient signatures per policy.

• Maintains knowledge regarding insurance reimbursement policies.

• Relies on experience and judgement to plan and facilitate discharge and transition plans, and assures they meet the physical, social, and emotional needs of the patient.

• Adheres to University and unit-level policies and procedures and safeguards University assets.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS                                                                                                         

Education:

Bachelor’s Degree/ Bachelor's Degree in Nursing

Certification and Licensing:

Registered Nurse (RN)

CCM a plus

Experience:

Minimum 2 years of relevant experience 

Knowledge, Skills and Attitudes:

• Ability to communicate effectively in both oral and written form.

• Ability to recognize, analyze, and solve a variety of problems.

• Ability to analyze, organize and prioritize work under pressure while meeting deadlines.

• Ability to maintain effective interpersonal relationships.

DEPARTMENT ADDENDUM

Department Specific Functions

The qualified medical professional chosen for this role will be responsible for identifying potentially complex clients who would benefit from a patient-centered care management program to ensure medically appropriate, high quality, cost effective care.

Care managers create longitudinal, personalized care plans for patients, collaborate with and coordinate the efforts with primary care providers and clinic based care teams, facilitate referrals throughout the system, and use data analytics to prioritize efforts and improve the health of patients.

• Supports and performs duties as directed and under the supervision of RN Manager Case Management.

• Collaborates with Primary Care Providers to develop and execute longitudinal care plan as per care team agreed upon patient care plan.

• High risk patient assessment, coordination and communication to care team input from all health professionals (care managers, social workers, clinical and non-clinical teams, etc.)  and assist with following a documented health care plan assuring continuity of care for the highest risk patients

• Communication and coordination between care settings: coordinate continuity of patient care with hospital case manager and follows up with patients following a hospital admission, observation discharge, and ER visits.

• Conduct post hospital discharge patient interview following agreed upon population health patient care team guidelines.

• Provides remote based care for patients needing closer follow up regarding medical monitoring, education, access to care and support.

• Along with physician hospitalists/PCPs/specialists, coordinates activities of interdisciplinary treatment team required to make high-risk clinical, benefit and network decisions

• Functions as main coordinator and manages a defined health population across multiple care settings and for multiple physicians/health care providers or health plan counterparts

• Coordinates care to assure appropriate utilization of resources while maintaining quality guidelines and clinical pathways.

• Works collaboratively with primary care practices to offer individualized assistance with improving and maintaining quality patient care.

• Overview of quality metrics and performance of assigned patient outreach in order to fulfill quality measures.

• Assists in the management of high-risk patient care, including management of patients with multiple co-morbidities or high risk for 30-day readmission to a hospital setting or frequent ED visits, using a registry

• Participates on a team for data collection, health outcomes reporting, clinical audits, and programmatic evaluation

• Attends Case Management Supervisor weekly patient care plan and health plan group meetings.

• Responsible for reviewing monthly health plan data/reporting.

• Assesses patient developmental progress at home and office visits, documents and promotes knowledge of development progress.

• Maintains a resource and referral file to assist families in finding timely and appropriate community-based programs and resources.

• Review and interprets patient developmental assessments (chronic condition programs, social determinants of health, etc.).

• Maintains ongoing communications with patients to capitalize on service effectiveness.

• Participates as a member of an interdisciplinary team while serving as point of contact for patient and families in need of early intervention services.

• Coordinates activities with other case-related medical and non-medical personnel.

• Collaborate with physician hospitalists/PCPs/specialists, coordinates activities of interdisciplinary treatment team required to make high-risk clinical, benefit and network decisions.

• Participates on a team for data collection, health outcomes reporting, Medicare Advantage HEDIS clinical audits, and programmatic evaluation.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.

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