Case Manager-RN - Inpatient Behavioral Health

General Summary

Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources to facilitate a patient's progression of care and the provision of appropriate, cost effective and quality health care. Works in a team model with social work in assigned patient care areas to address patient discharge needs. Provides leadership in the integration of utilization and case management principles.

Duties and Responsibilities

Inpatient Behavioral Health Case Manager Job Specifics:

Engages assigned patients using Motivational Interviewing strategies in the active management of their health by encouraging participation in their care and collaborating with all members of the interdisciplinary team including psychiatrist, medical provider(s), primary nurses, Social Work and Therapist.

Collaborates with discharge readiness team to enhance education and planning. Assistance, as needed, with patient understanding of medication management, outpatient follow up treatment, discharge transportation needs, and identifying and assisting with resolution of any obstacles relating to discharge.

Coordinates medical and psychiatric care and participates in Treatment Team to ensure best patient outcomes. Follows regulatory procedures to comply with treatment plan requirements. Ensure appropriate documentation of treatment team participants including required signatures.

Fosters a team environment that relies on the strengths of interdisciplinary team members, maintains patient as primary focus, and engages in flexible problem solving to create new and innovative strategies for addressing patient needs.

Establishes new relationships with providers, participates in meetings, and follows through with recommendations for the purposes of consultation, enhanced unit resources and education to increase patient care.

Oversees care progression in discharge readiness by rounding with care team, using clinical judgment to identify discharge readiness, risk of readmission while proactively identifying barriers. Initiate problem solving for delays and barriers.

Coaches and mentors clinical nursing staff in care coordination, situational awareness, and patient engagement to facilitate a positive patient experience. Engages in crucial conversations to ensure completion of effective and necessary interventions to enhance patient care and treatment progress.

Participates in daily communication with primary nurse, communicating any clinical concerns and assist in developing an action plan for the patient or update to Nursing Care Plan.

Facilitates nurse/provider rounds to assure patients are informed of and are included in their plan of care and discharge plan.

Ensures all necessary discharge paperwork including return to work/school letters, prescriptions to appropriate pharmacy or electronic submission are provided.

Coordination with families in collaborative treatment planning and patient progress as appropriate.

Assist patient care team with the identification and coordination of alternative treatment settings to provide appropriate care.

Coordinate with Case Management as indicated.

Participates in the review of policy and procedures on an ongoing basis providing evidenced-based revisions as necessary.

Participates in Quality Improvement endeavors through monitoring patient outcomes. Assists with the collection and analysis of utilization patterns including avoidable days and denied cases; shares this with assigned clinical leadership. Takes action to address these measures with the team as needed.

Reviews readmission metrics, communicates safety concerns and customer issues when appropriate, and increase team awareness of these events. Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).

Identifies educational opportunities. Uses a proactive and solution-oriented approach to meet defined objectives.

Case Manager Job Specifics:

• Reviews assigned patients for medical necessity, utilization management, and appropriateness of setting for continued hospitalization.
• Initiates problem-solving techniques to prevent over and/or under utilization.
• Facilitates and coordinates the progression of patient care to optimize throughput and the utilization of resources to support continuous quality and cost of care efforts.
• Liaisons between utilization management team, third party payers, and the treatment team regarding the identified treatment plan in accordance with contractual guidelines and System policy.
• Assists the patient care team with the identification and coordination of alternative treatment settings to provide appropriate care, maintain quality of care, and reduce cost.
• Identifies conditions which require case management across the care continuum. Collaborates with members of the patient care team to identify interdisciplinary needs
• Collaborates with care management across the system to effectively transition patient care and support value-based care initiatives.
• Completes case management patient assessment, identifies needs, develops a discharge plan, and coordinates discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families, and care team.
• Assists with the collection and analysis of utilization patterns, length of stay, readmissions, avoidable days, and denied cases.
• Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).
• Demonstrates a commitment to patient, visitor, and staff by complying with all applicable safety regulations, learning the impact of medical errors and methodology that will lead to reduction of errors; reporting actual and potential errors, as well as hazardous conditions; identifying opportunities to standardize processes and "error proof" systems that will lead to increased safety; and participating in safety education programs and root cause analyses as required.
• Prepares and maintains appropriate documentation as required.
• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
• Prepares and presents utilization data analysis as required.
• Participates in the development and delivery of educational information and process improvements related to job accountabilities and case management principles.
• Attends meetings as required.
• Performs other related duties as identified.
• WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity, and ethics. Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.
• WellSpan Health has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.

Qualifications

Minimum Education:

• Associates Degree Required
• Bachelors Degree Preferred

Work Experience:

• 2 years Recent acute care experience Required
• Field of Experience in Utilization Management, Case Management, or Clinical Nursing Specialty. Preferred

Licenses:

• Licensed Registered Nurse Upon Hire Required or
• Registered Nurse Multi State License Upon Hire Required and
• Basic Life Support Upon Hire Required
• Certified in Case Management Preferred

Knowledge, Skills, and Abilities:

• Excellent interpersonal and communication skills.
• Basic computer skills.
• Desire and ability to work in a supportive and collaborative team environment.