Under the general supervision of the Chief Nursing Officer (Medical/Telemetry Unit), the Registered Nurse Case Manager accomplishes the Department of Nursing strategic objectives by planning, organizing, managing, and leading the assigned functions required to operate and maintain patient care activities and services within the nursing scope and collaboration with the interdisciplinary team regarding discharge planning for assigned groups of patients including designated high-risk patients. The Registered Nurse Case Manager ensures that high-quality patient care is provided while focusing on efficiency during the patient’s overall hospital stay and discharge transition. Maintains confidentiality of all privileged information.

This list of duties and responsibilities is illustrative only of the task performed by this Position and is not all-inclusive.

Essential Duties & Responsibilities:

• Coordinate continuing care services to include utilization review, management, and discharge planning activities.
• Review admission data on patients to establish appropriateness of the admission using InterQual criteria.
• Coordinate continuing care and utilization review of Medical/Telemetry Unit, Emergency Department, and other clinical upon request.
• Conduct concurrent reviews to determine the continued need for acute care setting, appropriateness, and timeliness of treatments/procedures to optimize the potential for reimbursement.
• Identify and coordinate continuing care needs or potential home care recipients through assessment, interdisciplinary care rounds, and/or requests.
• Establish coordinated discharge plans based on the patient’s assessed needs, available family support, available community services, and the patient/family’s choice.
• Review incoming Swing Bed requests and coordinate with corresponding disciplines like rehabilitation services, wound care nurse, and Medical Doctor if the patient is a good candidate for our Swing Bed program. RN should be able to provide feedback to the referring facility within 12-24 hours
• Interface with external reviewing agencies and/or Case Managers regarding medical necessity, appropriateness of care, ongoing treatment plan and post-hospital discharge plan to ensure patient needs are met.
• Meet and comply with hospital policies and procedures.
• Maintain compliance with applicable laws, regulations, and ordinances, including the Arizona Department of Health Division of Licensing Services (AzDH), Centers for Medicare/Medicaid Services (CMS), and The Joint Commission.
• Complete required competencies for each unit assigned to work and hospital mandatory trainings each year.
• Provide Case Management coverage for Medical/Telemetry Unit, Swing bed Referral Request, Emergency Department, Outpatient Clinic, Diabetes Program, and the Community Health Nursing Department.
• Assess, establish, implement, and communicate goals, objectives, policies, and procedures in accordance with the nursing plan and practice.
• Initiate multidisciplinary collaboration, including patient, family, caretaker, and healthcare team, to ensure proper provision of patient care to meet assessed needs for psychological, psychosocial, environmental, educational, and discharge planning.
• Provide consistent and continuous case consultation with service providers.
• Maintain resource database to ensure timely and accurate information is available for patient services to promote streamlining of services.
• Initiate closure of case when all care services needs have been coordinated for patient.
• Collaborate with medical providers and internal and external discipline resources to plan and achieve patient-specific goals.
• Develop reports, policy & procedure manuals, and program objectives.
• Conduct system and process efficiency evaluation to determine progress, performance, and conformity with program requirements.
• Assist with managing outpatient referrals for the Health Care Management Department.
• Follow up with interfacility referrals initiated while inpatient for continuum of care, e.g., Public Health Nursing, follow-up appointments, etc.
• Provide quality customer service and maintain a positive working relationship with internal and external customers.
• Accept and adapt to change in work area and/or work duties as assigned.
• Ensure proper maintenance and organization of department and patient documentation.
• Participate in quality initiatives and performance improvement assignments for Case Management.
• Ensure strict confidentiality of all physicians, personnel, and patient information.
• Attend mandatory staff meetings.
• Report to work as scheduled, minimal absenteeism. Wear identification while on duty; uses computerized punch time system correctly.
• Maintain professional and technical knowledge through research; attending seminars, educational workshops, classes, and conferences; reviewing professional publications; establishing networks; participating in professional societies; conferring with representatives of contracting agencies and related organizations.
• Participate in CPI training, infection control, patient safety, fire safety, customer service and other mandatory training requirements annually.
• Treat all persons with courtesy and respect, including age, sex, social, and cultural differences.
• Maintain personal record of in-service participation.
• Demonstrate an ability to be flexible, organizes and function under stressful situations.
• If applicable to the position, the employee manages a 24-hour turnaround time for patient requests for callback.
• Participate in a code blue or other clinical emergencies for patients on the inpatient unit and in the Emergency Room Department (ER) and Outpatient Department, if needed.
• Perform other duties as assigned.

Minimum

Qualifications:

• Bachelor’s Degree in Nursing with experience in case management.
• If ADN, must be concurrently enrolled in an accredited nursing program pursuing a Bachelor's Degree or Master's Degree in Nursing with two (2) years of Case Management experience. Must present enrollment documentation to the Nursing program, proof of attendance, and anticipated date of graduation.
• Valid and unrestricted nursing license from the State of Arizona or compact licensing state.
• Valid American Heart Association Healthcare Providers BLS certification.
• Must obtain a valid American Heart Association Healthcare Providers ACLS certification within 90 days of hire.
• Must be able to successfully pass the Employee Health Program requirements and background investigation.

Knowledge, Abilities, Skills, and Certifications:

• Knowledge of and ability to interpret applicable tribal, federal, state, local laws, and regulations.
• Knowledge of and ability to interpret the AzDH, CMS, and The Joint Commission standards for accreditation and compliance.
• Knowledge of business English, proper spelling, grammar, punctuation, and mathematics.
• Ability to communicate effectively in the English language both verbally and in writing with staff and the public.
• Knowledge of ethical principles, standards, and practices.
• Knowledge of standards of care for patient care.
• Knowledge of the abuse and domestic violence policy and procedures.
• Ability to perform effective interpersonal skills and able to function at a high level of independence.
• Ability to establish and maintain professional relationships with individuals of varying social and cultural backgrounds and with co-workers at all levels.
• Ability to work effectively with individuals and demonstrate team-building skills.
• Ability to react calmly and effectively in emergency situations.
• Ability to speak the Navajo language and/or familiarity with the Navajo Way.
• Ability to work independently and meet strict timelines.
• Ability to continually seek improvement in results.
• Skill in operating business computers and office machines, including Microsoft Programs (Windows, Excel, PowerPoint, etc.).
• Skill in analyzing problems, projecting consequences, identifying solutions, and implementing recommendations.

Physical Demands:

While performing the duties of this job, the employee is regularly required to stand, walk, crouch, kneel, and sit; use hands and fingers to grasp objects; reach with hands and arms; and to talk and hear. The employee must occasionally lift and/or move up to 50 pounds.

Work Environment:

Work is generally performed in an office, clinic, or hospital setting with exposure to potentially dangerous materials and situations that require following extensive safety precautions and may include the use of protective equipment and exposure to bloodborne pathogens. Exposure to latex products on a routine basis. Evening and/or weekend work may be required. Extended hours and irregular shifts may be required.