Erie County Medical Center NURSE CASE MANAGER in Buffalo, New York
DISTINGUISHING FEATURES OF THE CLASS: The work involves developing and coordinating patient care
services utilizing the case management model. This is a Registered Professional Nursing position. The incumbent serves as a liaison for the Department of Nursing and the Department of Medicine/Surgery focusing on an interdisciplinary team approach to promote quality patient care while achieving desired patient outcome in a time-efficient, cost effective manner. Work is performed under the general supervision of higher level professional nursing administrator. Supervision is exercised over professional, paraprofessional and clerical staff assigned to patient care cases. Does related work as required.
TYPICAL WORK ACTIVITIES:
Familiarizes self with and monitors assigned patient's medical/psychosocial history and keeps track of their major sequence of events during current hospitalization;
Introduces self to patient/family to explain the role of the case manager and group practice;
Contacts physician(s) to share assessments, goals, and plans for the patient's hospital stay and episode of illness and knows the anticipated diagnosis-related group (DRG), length of stay, and transfer/discharge dates;
Collaborates with physician(s) and/or interdisciplinary team(s) to develop critical paths and case management plans (CMP) for specific medical diagnoses;
Selects initial CMP and critical pathway, if established, and coordinates early discharge planning with Social Services;
Accompanies and assists physician on rounds;
Keeps physician and/or interdisciplinary team informed on current patient status;
Consults with physician and/or interdisciplinary team on patient progress toward expected outcomes and methods needed to achieve desired outcome;
Identifies, analyzes and takes corrective action for patterns of variance that emerge within CMP or critical pathways selected for a patient;
Compares the standard case management plan with the patient's individual needs in such areas as social and economic data, family resources, functional abilities, knowledge needs, potential risk factors and complications, and special concerns or issues;
Assess and evaluates each patient's plan of care daily;
Reviews admissions to hospital within one (1) business day of patient arrival;
Compares patient health record to licensed criteria to determine if admission can be certified for provision of acute care;
Identifies or assists physician in identifying safe level of care or treatment; issues level of care letters in accordance with ECMCC policies and third-party payer guidelines;
Completes paperwork for patient discharge, in accordance with third-party payer guidelines, when acute care is no longer necessary;
Coordinates the alternate level of care (ALC) documentation process for patients deemed unable to stay in the hospital for acute care or not admitted to long-term care setting;
Requests physician review of cases and related documentation to support ALC orders;
Completes Patient Review Instrument (PRI), in accordance with New York Codes, Rules and Regulations, Title 10, Part 85.8, and utilizes resulting score/measure to determine if patient meets admission criteria;
Assists in monitoring Electronic Health Record (EHR)/Electronic Medical Record (EMR) compliance and activity.
FULL PERFORMANCE KNOWLEDGE, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS:
Thorough knowledge of the principles and practices of professional nursing; thorough knowledge of current nursing practices and techniques used to provide total patient care; thorough knowledge of ECMCC policies and procedures, applicable laws, rules and regulations, accreditation standards, and third-party payer guidelines that relate to the admission process and alternate level of care; thorough knowledge of diagnostic related groups (DRG) and length of stay as they relate to reimbursement in New York State; thorough knowledge of required documentation for admission process and alterative level of care; good knowledge of medical case management planning, principles and techniques; good knowledge or electronic health records and electronic medical records; ability to perform, comprehend and interpret scores resulting from Patient Review Instrument; ability to communicate effectively, both orally and in writing; ability to establish and maintain effective working relationships with a diverse constituency; ability to utilize a variety of electronic software applications; sound professional judgment; capable of performing the essential functions of the position with or without reasonable accommodation.
A) Graduation from a regionally accredited or New York State registered college or university with a Master's degree in Nursing and three (3) years of acute hospital nursing experience, at least one (1) year in acute medical nursing; or:
B) Graduation from a regionally accredited or New York State registered four (4) year college or university with a Bachelor's degree in Nursing and five (5) years of acute hospital nursing experience, at least two (2) years in acute medical nursing; or:
C) An equivalent combination of training and experience as defined by the limits of (A) and (B).
Possession of a license and current registration to practice as a Registered Professional Nurse in the State of New York at the time of appointment and maintenance throughout period of employment;
Possession of Basic Life Support (BLS) Certification at time of appointment and maintenance throughout period of employment;
Possession of Patient Review Instrument (PRI) Certification as administered by New York State Department of Health within twelve (12) months of appointment and maintenance throughout period of employment.
NOTE: Verifiable part-time and/or volunteer experience will be pro-rated toward meeting the full-time experience requirements.