Overview Manage the resources necessary and appropriate for the provision an achievement of patient care outcomes, in collaboration with the clinical team, providing leadership for the management of patient care and resulting outcomes. Responsibilities Clinical Case Management Determines patient needs and resources within 1-2 business days of admission. Initiates discharge planning process. Maintains communication with UM coordinator regarding assessments, outcomes, and projected lengths of stay. Serves as a resource to the healthcare team, communicating with the physician, consultants, and all members of the healthcare team. Participates with the physician/multidisciplinary to review the plan and progress of care, to evaluate the effectiveness of interventions and to recommend modification(s) to the plan, as necessary to meet identified patient care goals. Collaborates actively and functions in a multidisciplinary department to provide comprehensive full spectrum care coordination and discharge planning for each patient. Coordinates transfers to appropriate facilities when applicable. Secures authorization for needed additional patient services, as required. Serves as an educational resource to clinical staff around case management. Documents case management assessments and interventions as appropriate, adhering to current standards and policies. Coordinates family and patient meetings in order to develop a comprehensive plan of care during and post hospitalization. Supports the job functions of the other members of the OCM team, as needed Consults with and provides Case Management support to outpatient departments on case-by-case basis and as time allows Performs other duties as required or assigned. Qualifications 3 years of experience in a clinical or community care setting. Experience at a Critical Access Hospital preferred Must have excellent written and verbal communication skills Must be able to work as an integral player in a team environment Basic computer skills Demonstrated ability to be flexible and able to function under stressful situations Good organizational and problem-solving skills Clinical Pathways, utilization management, and discharge planning knowledge preferred. Required Licensure/Certifications

REQUIRED LICENSE

(S):

• Licensed RN with NH eligibility