Nurse Case Manager – Full Time, DAYS Position Available In Columbia, New York

Job Description:

Kinderhook, NY, United States Department/Unit:

CareManagement/Social Work Work Shift:

Day (United States of America)

Salary Range:

$71,612.39 – $110,999.20 The Case Manager isaccountable to facilitate the interdisciplinary team to plan,coordinate, implement and evaluate patient care for assignedservice line across the continuum of care. The Case Manager worksproactively with the Quality Improvement Teams, patient carestandards, Social Work, and utilization management to coordinatethe appropriate use of resources to achieve maximum clinical andfinancial outcomes. The Case Manager participates in maintainingquality care and performance improvement through leadership,problem solving, decision making, and outcome measurement. The CaseManager functions as a resource for the health care team,community, patient/significant others/family and payers byfunctioning as a clinician, consultant, advocate and educator forassigned service. Principal Position Responsibilities 1.Coordination of Care a. Assists the admission MD and or designatedphysician and the interdisciplinary teams in assuring coordinationof care across the continuum of care in the hospital pre andpost-op. b. Proactively monitor patients’ clinical process through/patient care standards and evidence-based guidelines to ensuretimely, appropriate interventions that achieve optimal patientoutcomes within appropriate LOS and financial constraints. c.

Provides collaborative care management with the primary nurse inassessing for discharge planning needs, coordinating appropriateresources and evaluating effectiveness of the discharge plan. Thedischarge planning process needs to begin on admission. d.

Collaborates with the health care team and appropriate departmentin the management of care across the continuum of care, includingpre-admission, discharge, post-discharge, planning length of stay,and utilization of resources. e. Utilizes own special body ofknowledge and evidence based guidelines to provide leadership andguidance to the health care team in formulating an individualizedmultidisciplinary plan of care to include: pre hospitalization,acute hospital care, discharge education, transition to home anduse of community resources. f. Facilitates and participates inhealth care team care conference for patients with complexproblems. g. Facilitates patient and family education and thedischarge process to promote continuity of care and optimal patientoutcomes. h. Demonstrates experience in the referral process anduse of community resources. 2. Utilization Review a. Reviews datafrom admission screening to clarify admission diagnosis, establishappropriate length of stay, and identify any potential outliers anddetermine appropriateness of admission based on institutionalstandards and evidence based guidelines. b. Contacts payer sourceto confirm/negotiate benefits and provide concurrent reviews. c.

Identifies capitated patients to determine appropriate utilizationof series and coordinates post hospital care using definedstandards. d. Identifies high-risk patients based on clinical andfinancial criteria for collaboration with patient financialservices to problem-solve available resources. e. Ensures thatappropriate medical/legal documentation is contained in patient’srecords. f. Complies with regulations established by third partypayers including but not limited to notices of non-coveragereinstatement and continued stay. g. Follows department UMguidelines. 3. Quality Improvement a. Collaborates with the healthcare team in implementing strategies to reduce length ofstay/resource consumption to optimize patient health status for anassigned service patient. b. Assesses educational needs andprovides learning opportunities for health care professionalsrelevant to particular cases and selected patient care groups. c.

Demonstrates creativity and critical thinking ability in thedevelopment of programs or projects. d. Works with qualityimprovement team for continuous improvement of patient careoutcomes while increasing quality and decreasing cost. e. Ensurethat communication and transmission of documentation occurs withcommunity agencies. 4. Measurement a. Collaborates with casemanagement leadership to compile and report aggregate variances anddata for specific patient care services. b. Communicates andanalyzes aggregate variances with members of the health care teamand develops strategies for variance reduction. Qualifications andIdeal Characteristics 1. Registered nurse with a current license.2. Bachelor’s degree required preferred Master’s degree preferred.3. Minimum of three years clinical experience in an assignedservice. Acute care nursing experience preferred. 4. Recentexperience in case management, utilization management and/ordischarge planning/home care in a high volume, acute care hospitalpreferred. PRI and Case Management certification preferred. 5.Demonstrates effective communication, facilitation, andorganizational skills. 6. Assertive and creative in problemsolving, critical thinking skills, systems planning and patientcare management. 7. Self-directed with the ability to adapt in achanging environment. 8. Basic knowledge of computer systems withskills applicable to utilization review process. Mission, CoreValues and Service Excellence 1. Contributes to the creation of acompassionate and caring environment for patients, families, andcolleagues through displays of kindness and active listening.

Recognizes and appreciates that each employee’s work is valuableand contributes to the success of the Mission. 2. Demonstratesexcellence in daily work. Willing to actively participate inperformance and quality improvement activities and to work towardsenhancing customer/patient satisfaction. 3. Exhibits positiveservice excellence skills to patients, visitors, and coworkers bygreeting others in a friendly manner, keepingcustomers/patients/colleagues informed about progress, delays, andchanges. 4. Demonstrates effective teamwork by interacting in apositive manner with colleagues and creating a collaborative workenvironment. Initiates open communication, conveys positive intent,offers assistance. 5. Contributes to a safe and secure environmentfor patients, visitors, colleagues by following establishedprocedures and protocols. 6. Demonstrates stewardship by thoughtfuland responsible use of resources including maintaining a clean andhospitable environment, starting work on time, displaying aconsciousness regarding costs, supplies and department finances. 7.Demonstrates respect for individual differences of each person byacknowledging the essence of each person, appreciating, andresponding to unique, spiritual, personal, and cultural backgroundsof patients, families, and colleagues. Physical Demands Thephysical demands described here are representative of those thatmust be met by an employee to successfully perform the essentialfunctions of this job. While performing the duties of this job, theemployee is regularly required to stand, walk, use hands to probe,handle, or feel objects, tools, or controls, reach with hands andarms, and speak and hear. The employee is occasionally required tosit and stoop, kneel, or crouch. The employee must regularly liftand/or move up to 50 pounds. Specific vision abilities required bythis job include close vision, distance vision, peripheral vision,depth perception, and the ability to adjust focus. Work EnvironmentThe work environment characteristics described here arerepresentative of those an employee encounters while performing theessential functions of this job. While performing the duties ofthis job, the employee may be subject to infectious materials andchemicals (see unit specific MSDS information). The noise level inthe work environment is usually moderate. This job requires as anessential function that the majority of the time the employee bephysically on-site as the work cannot be done from a remotelocation. Other Requirements All job requirements listed indicatethe minimum level of knowledge, skills, and/or ability deemednecessary to perform the job proficiently. This job description isnot to be construed as an exhaustive statement of duties,responsibilities, or requirements. Employees will be required toperform any other job-related instructions given by their su Thankyou for your interest in Albany Medical Center!? Albany Medical isan equal opportunity employer. This role may require access toinformation considered sensitive to Albany Medical Center, itspatients, affiliates, and partners, including but not limited toHIPAA Protected Health Information and other information regulatedby Federal and New York State statutes. Workforce members areexpected to ensure that: Access to information is based on a “needto know” and is the minimum necessary to properly perform assignedduties. Use or disclosure shall not exceed the minimum amount ofinformation needed to accomplish an intended purpose. Reasonableefforts, consistent with Albany Med Center policies and standards,shall be made to ensure that information is adequately protectedfrom unauthorized access and modification.