Shire Jobs

Northern Light Mercy Hospital

Department: Primary Care - Pediatric

Position is located: Mercy Medical Office Building

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 7:30 AM to 5:30 PM

Summary:

The Care Manager/RN as part of a multidisciplinary team, including physicians, and payors, ensures the patient's progress in the acute episode of care through post discharge and is quality driven while being efficient and cost effective. The RN Care Manager and MSW Care Manager work collaboratively to ensure patient needs are met and care delivery is coordinated across the continuum. The RN Care Manager seeks the expertise of the MSW Care Manager to resolve psychosocial patient care issues and to develop complex patient transition/discharge plan as needed. The incumbent interacts with patients, family members, healthcare professionals, community and state agencies in this effort. The Care Manager/RN serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information. The Care Manager/RN is responsible for maintaining hospital compliance with the Quality Improvement Organization (QIO) series and CMS guidelines. In addition, the Care Manager/RN provides case review information to third party payers and assists in the denial and appeals process as well as assessing quality, levels of care and identifying and reporting potential risk management issues. The incumbent performs duties and tasks in accordance with performance standards established for the job. The incumbent may have access to highly confidential patient, employee and/or hospital proprietary information, and must handle and protect the information in accordance with hospital and system policies, HIPAA requirements and the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, or other security risks to the organization. The incumbent is responsible for participation in and completion of all patient safety initiatives appropriate to the position. In addition, the incumbent conducts all job responsibilities according to the Mission and Values of the Hospital.

Responsibilities:

1. Works in conjunction with physicians, nurses, Care Management Team and others to assess, plan and initiate patient plan of care. • Reviews patient charts daily or as needed. • Utilizes MSW Care Manager for appropriate referrals: patient/families with complex psychosocial, on-going medical discharge planning issues, continuing care needs and end of life issues. • Attends focus of care rounds per unit policy. • Communicates targets and identified standards of care through collaboration with multidisciplinary team to reduce LOS and resource consumption. • Collaborates with patients, families and other members of the interdisciplinary team as needed. • Insures that all critical elements of the care and discharge plan have been communicated to multi-disciplinary team, patient and family including expediting teaching needs. 2. Facilitates and coordinates details of actual discharge to appropriate agencies. • Initiates discharge plan within 24 hours of admission • Provides and updates referrals to facilities through online/software discharge planning tools. • Reviews and completes all appropriate information accompanying patient facility. • Acts as a liaison between hospital and post acute facilities to facilitate returns/admissions. • Facilitates arrangements for time and mode of transportation to facilities for patients. 3. Facilitates and coordinates individualized discharge plan. • Arranges and participates in care conferences with unit staff, home care staff, patients and/or families. • Provides adequate avenues of communication through on-going documentation in Meditech, eDischarge and telephone/verbal reporting or electronic tools. • Coordinates and communicates with home care agencies regarding expected standards of care for requested specific treatments. • Identifies and provides information on requested procedure or medicines. 4. Serves as a resource to physician and hospital personnel regarding available agency, facility, and community services to assist in discharge planning. • Discusses specific continuing care needs with physicians and hospital personnel on a regular basis. • Collaborates with other Care Management team members as needed. 5. Completes appropriate State of Maine forms. • Monitors the completion of the MED for all first time Mainecare transfers to nursing facilities. • Alerts contracted agency to complete The MED on Mainecare patients with expired bed holds. • Alerts contracted agency to complete The MED on Mainecare patients with need for community programs. 6. Ensures adherence to Quality Standards and Participation in Quality Monitoring and Improvement • Participates in departmental and hospital Quality Improvement programs by documenting the required indicators in Midas for focused review. • Documents disposition of patient at discharge. • Provides adequate documentation of initial assessments, on going of progress notes in Meditech and reviewing of all referrals for accuracy and content prior to discharge. • Accepts responsibility for further development of professional learning and growth. • Actively participates in interdisciplinary projects using the Quality Improvement plan. 7. Medical Record Review: • Conducts inpatient admission reviews for appropriateness of setting. • Conducts on-going case review for continued stay criteria and enters data. • Monitors quality of care using predetermined criteria. • Reports potential risk management issues as through medical record review. • Enters data as requested to support Quality Improvement initiatives in Midas. 8. Third party payer Reporting: • Using approved criteria conducts admission and continued stay review to ensure appropriateness of the setting and timely implementation of the plan of care, to monitor the patient’s progress along the continuum of care and intervenes as necessary to ensure appropriateness of setting and that the services provided are quality, efficient and cost effective • Consults with Physician Advisor and leadership as necessary to resolve barriers through appropriate administrative and medical channels. • Responds to requested telephonic insurance reviews involving admissions, continued stay, and discharge planning as well as contact for onsite reviewers. • Documents in appropriate electronic system by the close of business each day. • Communicates with admitting and pre-certification regarding level of care status.

Other Information:

BLS Required. Additional education and experience may be required.

Competencies and Skills

• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.

• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.

• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.

• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Credentials

• Required Registered Nurse

Education

• Required No Minimum Requirement

Working Conditions

• Potential exposure to abusive and/or aggressive people.

• Potential exposure to diseases or infections.

• Potential exposure to hazardous materials.

• Potential exposure to noise levels being uncomfortable.

• Potential exposure to noxious odors.

• Potential exposure to very hot or cold temperatures.

• Work with computers, typing, reading or writing.

• Lifting, moving and loading 20 to 30 pounds.

• Prolonged periods of standing.

Position Care Manager- RNLocation Req ID null