Job Description

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Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The Care Manager is responsible and accountable for ensuring high value patient care that is coordinated, efficient and aligned with institutional clinical and financial objectives. In collaboration with the healthcare team, the Care Manager utilizes evidence based practice to ensure that specific patient outcomes are reliably achieved and that resources are appropriately used within designated fiscal time frames. With our members of the health care team, the Care Manager participates in the ongoing evaluation of practice patterns and supports efforts to improve patient care and enhance efficiency of operations. The Care Manager interacts with others in the identification of trends and barriers to all aspects of care. Through this interaction, the Care Manager identifies and works toward a resolution as a part of the multidisciplinary team.

EEO/AA/Disability/Veteran
Responsibilities

• 1. 1. As part of the interdisciplinary health care team, coordinates and ensures the implementation of the plan of care, utilizing the principles of case management. 1.1. Establishes a system for coordinating the care of a patient throughout the continuum of care, linking the inpatient care with outpatient care, services and case management. 1.2. Reviews the healthcare information with healthcare team. Reviews the admitting diagnosis/problems with the healthcare team. Monitors the course of patients and the adherence of this course to clinical pathways or the patients\' treatment plan. 1.3. Reviews the plan with physician, primary nurse and other members of the team as appropriate and insures that communication is taking place with patient and family. 1.4. Demonstrates the knowledge and skills necessary to provide care needs appropriate to the age of the patients served on his or her assigned patient populations. 1.5. Facilitates communication within the health care team and with the primary care physician and other disciplines to coordinate patient\'s progress through clinical pathways or the patient\'s treatment plan. 1.6. Ensures that the sequencing and scheduling of interventions, treatment, and procedures are in accordance with the clinical pathways or the patient\'s treatment plan.
• 2. 2. Optimizes the efficiency of hospital systems which impact quality and/or length of stay 2.1. Identifies and monitors compliance with documenting variances from established parameters in the clinical pathway or treatment plan. 2.2. Collaborates with other departments to accelerate scheduling and to facilitate access to tests and consultations. 2.3. Identifies trends, themes, and consistent barriers and work collaboratively with healthcare team 2.4. Intervenes when necessary to correct delays and to address any barriers for patients.
• 3. 3. Utilizes information obtained from various resources available to: 3.1. Ensure that each patient meets the clinical needs for admission, treatment, and discharge and initiates appropriate follow through with the health care team. 3.2. Collaborate with health care team to initiate referrals to the appropriate service and/or provider, ensuring that adequate insurance coverage and reimbursement are obtained. 3.3. Identify patients who are likely to have unmet insurance and resource needs and communicate with healthcare team members and other appropriate departments. 3.4. Communicate as needed with third party payors regarding the patient\'s progress with the treatment plan. 3.5. Collaborates with case manager and representatives from third party payor regarding services available when barriers are identified. 3.6. Review admissions daily to ensure appropriateness.
• 4. 4. Assist clinicians in documenting the appropriateness of admissions and continued stays 4.1. Responsible for Medicare notices of non-coverage and help provide appropriate documentation to appeal inappropriate denials. 4.2. Appeal of inappropriate insurance denials
• 5. Ensures that an appropriate discharge plan is developed and implemented with the health care teams members to include: 5.1. Identifying service, treatment and funding options; 5.2. Advocating for individual needs as indicated; 5.3. Identifying gaps in the treatment and/or discharge plan 5.4. Utilizing knowledge of internal and external resources to meet patient needs; 5.5. Identifying barriers to wellness within the treatment plan; 5.6. Coordinating and scheduling interdisciplinary meetings with the patient and family regarding discharge needs and the plan; 5.7. Ensures and/or coordinates counseling and teaching for discharge preparation.
• 6. 6. Ensures that the discharge plan provides a continuum of care with the appropriate outpatient physician and needed services.
• 7. 7. Ensure that the appropriate outside agencies are contacted and necessary referrals are initiated and followed through. 7.1. Links patient and family with the appropriate institutional or community resources, advocating on their behalf for scarce resources, and developing new resources where gaps exist in the service continuum. 7.2. Ensure that appropriate services are provided and that necessary certifications for these services are carried out.
• 8. 8. Works collaboratively with PSM and unit leadership team to actively involve clinical nurses in the assessment and planning for patient\'s discharge to facility.
• 9. 9. Along with other members of the health care team, acts as a patient advocate. 9.1. Exhibits awareness of ethical/legal issues concerning patient care and strives to manage situations to reduce risk. 9.2. Educates patients and families regarding the care manager role, as needed. 9.3. Facilitates and ensures open communication among the health care team and the patient/family. 9.4. Performs miscellaneous duties as required or requested.

Qualifications

EDUCATION

Minimum of a Baccalaureate degree in clinically related field. R.N. required

EXPERIENCE

Minimum of four (4) years of relevant clinical experience

LICENSURE

RN Licensure in Connecticut

SPECIAL SKILLS

Lead Transitional Care rounds with physicians, nurses and other members of the health care field. Case Management experience a plus.

PHYSICAL DEMAND

None

Additional Information

keen critical thinking skills, works well individually as well as in a team. Organized, proactive
YNHHS Requisition ID

87976

Yale New Haven Health System