SCHEDULE: PRN/Per Diem
St. David’s South Austin Medical Center is part of St. David’s HealthCare, one of the largest health systems in Texas, which was recognized with a Malcolm Baldrige National Quality Award in 2014. St. David's South Austin Medical Center is an acute care facility with 316 beds, offering a range of complex specialties and sub-specialties, including a nationally accredited oncology program with the area’s only adult bone marrow transplant program; a trauma program that includes all of the capabilities and programmatic elements of a Level II trauma center to treat the most severely injured and critical patients; a comprehensive cardiac program; full-service maternity and newborn care with Level I and II nurseries; and two full-service emergency centers in the communities of Bee Cave and Bastrop.
The Case Manager will facilitate the interdisciplinary plan of care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care, and resource management. The Case Manager will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization. The Case Manager will identify potential barriers to patient throughput and quality outcomes. The Case Manager will facilitate appropriate discharge plans.
- Performs a comprehensive assessment of psychosocial and medical needs of assigned patients
- Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the medical record; plan is communicated to appropriate clinical disciplines
- Assumes a leadership role with the interdisciplinary team to manage care, through criteria driven processes, for the appropriate level of care, patient status and resource utilization
- Evaluates admissions for medical necessity using approved criteria at defined intervals throughout the episode of care; escalates medical necessity and admission status issues through the established chain of command
- Evaluates and assess observation patients for appropriateness in observation status
- Performs utilization management reviews and communicates information to third party payors
- Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies
- Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services
- Makes appropriate referrals to third party payer disease and case management programs for recurring patients and patients with chronic disease states
- Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team
- Facilitates patient throughput with an ongoing focus on quality and efficiency
- Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems
- Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals
- Assesses patients’ post discharge needs and facilitates the provision of services necessary to meet identified needs
- Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered
- Identifies patients with the potential for high risk complications and makes appropriate referrals acting as an advocate for the individual’s healthcare needs
- Directs activities to identify and provide for the needs of the under resourced patient population to include patient education activities, patient assistance programs, and community based resources
- Develops individual plans of care for recurring patients to include education on appropriately accessing healthcare resources, preventative education, and community based resources
- Assumes a leadership role in the development, revision, and implementation of clinical protocols which transition patients across the continuum of care or discharge patients to an appropriate service level of care
- Tracks and trends variances to care and barriers to care; makes recommendations and develops action plans to improve processes and systems
- Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely
WORK ENVIRONMENT: This position operates within the confines of the hospital building and general office environment. Hours and shifts may vary to include holidays, weekends and evenings. On-call may be required.
Required: RN with current state licensure, BSN preferred.
Required: Minimum two years experience in clinical field within an acute health care setting. Ability to establish and maintain collaborative and effective working relationships. Ability to communicate effectively in oral, written and electronic formats. Demonstrates analytical and critical thinking abilities with pro-active decision-making and negotiation skills. Demonstrates an ability to perform specific competencies as identified on the Case Management Competency Grid
Preferred: Three years nursing experience in acute care setting, Case Management experience preferred. Certification in Case Management, Nursing, or Utilization Review, preferred.
Required: Licensed as a Registered Nurse in the state of Texas.