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A Little More About What You Will be Doing

The Lead Case Manager will assist in the daily operations of the inpatient case management department. Primary responsibility is to provide oversight of the daily functions of the inpatient case managers. The inpatient case manager conducts case management on patients in the inpatient, and Skilled Nursing Facility settings. CSMNS has developed a case management program that is geared towards the management of patients while hospitalized and upon discharge from various care settings. Using the Case Management Society of America?s (CMSA) model, we describe our approach as "a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes. In collaboration with the Inpatient Specialty Program (ISP) hospitalists (physicians who practice hospital medicine) and the Clinical Integration (C.I.) Community physicians, the program is designed to assist patients from the time they are admitted until they are discharged from the hospital by assessing their needs, coordinating care, communicating with health plans (including concurrent review, which assists the hospitalist/specialist and case manager to determine the appropriateness of services rendered and to ensure that quality care is delivered in a cost-effective manner), and referring to disease management programs and ambulatory case management (focus is on those members requiring complex and/or chronic care for follow up after discharge).

Job duties and responsibilities:

• Care manager meets with patients within 24 hours of admission and conducts an initial assessment.
• Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patient?s stay.
• Submit necessary clinical information to the health plan using the accepted formats (MCG/InterQual and coordinate health plan communication with assigned hospitalist as appropriate.
• For patients who are transitioning to the Skilled Nursing Facilities, refer to nurse practitioner and case manager assigned to the SNF?s for continued review and follow up.
• Authorize all appropriate services based upon covered benefits and necessity of care provided.
• Coordinate discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate.
• Secure outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers.
• Referral to Ambulatory Case Manager for those patients identified that will need oversight of outpatient care and compliance to avoid unnecessary readmissions.
• Coordinate referrals and secure appointment with various CSMNS disease management programs such as anticoagulation clinic, Asthma, Diabetes, Hepatitis C, smoking cessation, cardiovascular risk reduction and nutrition, as appropriate.
• Enter and update all authorization and clinical information into Nautilus (Access Express) no later than date of discharge.
• Ambulatory case managers will contact the patients telephonically shortly after discharge or may sometimes meet with them in their respective doctors? offices.
• Monitor 30-day readmissions
• Function as the contact person for clinical issues, workflow processes, and as a triage/resource to MDN inpatient case management operations.
• Manages staffing schedule, responds to sick calls and unscheduled absences and adjust staffing accordingly. Assists with training new hires; oversees projects and initiatives as assigned; and conducts documentation audits.

Education:

• Graduation from an accredited school of nursing required
• Bachelor of Science in Nursing degree required

License/Certifications:

• Valid CA RN license required
• Certified Case Manager certification preferred

Experience:

• 3 years of acute nursing experience required
• 3 years of previous experience in case management, discharge planning, utilization review, and HMO in the acute inpatient or outpatient settings preferred