The RN, Hospital Inpatient Case Manager provides case management for all A/B and observation patients in our contracted facilities. Accomplishes patient care by assessing treatment needs, and developing, monitoring and evaluating treatment plans and progress. Facilitates interdisciplinary approach to appropriate care for hospitalized hospice patients. Prepares patients and families for discharge to appropriate care sites by reviewing and amplifying discharge plans. Coordinates discharge and post discharge requirements; orienting and training family members and/or care teams.
- RN (BSN preferred) with current Florida license
- Minimum of 3 years' clinical experience with recent acute care hospital experience preferred; Hospital, Home Health or Hospice experience required
- Strong CM knowledge and physical assessment skills required
- Ability to counsel and problem solve with patient/families and work as a team member
- Excellent communication skills
- Ability to manage physical demands and emotional stress of caring for terminally ill patients and their families
- Physical ability to access any home, hospital, NH and ALF (i.e., navigate stairs, narrow spaces, lack of air conditioning, heat, etc.); contact with patients with communicable diseases may be necessary
- Ability to work with minimal supervision, manage multiple priorities simultaneously and exercise discretion and use independent judgment and critical thinking skills
- Extraordinary time management and organizational skills required
- Satisfactorily completes competency requirements for this position.
- Assesses, plans, implements, coordinates, monitors and evaluates options to facilitate care and discharge.
- Determines patients' requirements by completing intake interviews; determining need for therapeutic medical, psycho-social, and spiritual evaluations; reviewing therapist evaluations, treatment objectives, and plans.
- Establishes treatment plans by setting schedules and routines; coordinating services being provided; arranging resources, including transportation.
- Provides notice in a timely manner to other departments for discharge needs i.e. pharmacy, DME, RT, etc.
- Monitors cases by verifying patients' condition, observing and evaluating treatments and responses; advocating for needed services and entitlements; obtaining additional resources; intervening in crises; providing personal support.
- Ensures appropriate hospice Level of Care documented in EMR.
- Maintains patients' records by reviewing case notes; logging events and progress.
- Communicates patients' progress by conducting weekly interdisciplinary meetings and evaluations; disseminating results and obstacles to therapeutic team and family; identifying treatment influences.
- Prepares clients' discharge by reviewing and amplifying discharge plans; coordinating discharge and post-discharge requirements; orienting and training family members; providing resources.
- Manages the Interdisciplinary Group (IDG) towards prompt effective and safe discharge of patient and family to next setting.
- Educates physicians and IDG regarding appropriate level of care/utilization issues.
- Collaborates with hospital systems to ensure proper utilization of patient care resources.
- Attends and actively participates in all patient conferences and planning.
- Enhances department and Organization's reputation by accepting ownership for accomplishing new and different requests; explores opportunities to add value to job accomplishments.