Case Management Outcomes Coordinator (RN) - Good Samaritan Hospital - Full time - day
General Summary: Under the general supervision of the Director-Case Management, performs a variety of duties and oversees the progression of care and outcomes for assigned patients. Utilizes case management experience to address care coordination for assigned patients based on STEEEP principles. Coaches and mentors physicians and bedside staff in day to day care coordination and work flows in pursuit of the best patient outcomes. Works in a team model of care involving the patient, hospitalist team, Case Manager, Social Worker and bedside staff to address timely and efficient patient discharge. Oversees data collection and outcomes for assigned patients and works with leadership to identify trends, pursue care improvements and celebrate accomplishments. Provides leadership in the integration of utilization and case management principles throughout the Hospital. Demonstrates tenacity for follow through with tasks, self-directed in day to day work and displays leadership and team work in ones accomplishments.
Duties and Responsibilities: The following are essential job accountabilities: 1 Engages assigned patients in the active management of their health by encouraging participation in their care and collaborating with the providers on the plan of care, arranging family meetings and successfully completing motivational interviewing training. 2 Understands the principles of medical necessity and proactively works with CM staff to execute the discharge plan and procurement of services/ equipment and coordinates with providers of assigned case load. 3 Coaches and mentors clinical staff in care coordination, situational awareness, and patient experience caring behaviors, patient engagement. 4 Oversees care progression including assessing discharge readiness of assigned patients; leads SIBR rounds, identifying DRG LOS targets using DRG software and clinical judgement to predict discharge readiness, readmission risk, proactively managing barriers and trends in care inefficiencies/ delays to prevent over and/or underutilization using the Avoidable day tracking tool. 5 Coordinates all necessary paperwork and referrals for assigned patients including: return to work letters, medical necessity forms, Utilization review notices- IMM and observation, and initiates problem-solving for delays/barriers. 6 Assists the patient care team with the identification and coordination of alternative treatment settings which will provide appropriate care, maintain quality of care and reduce cost. 7 Identifies conditions which require case management across the continuum. Collaborates with the members of the patient care team including Care Coordination Teams, to identify interdisciplinary needs and effective TOCO status communication with staff. 8 Monitors, communicates and assists discharge needs when identified (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed. 9 Assists with the collection and analysis of utilization patterns including avoidable days and denied cases; shares this with assigned clinical leadership. 10 Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s). Case Management Outcomes Coordinator Page 2 11 Concordantly tracks identified quality metrics and takes action to address these measures with the team as needed. Review Readmission, log safety concerns and customer issues when appropriate, and increase team awareness of these events.
Required Skills: Bachelor's Degree in Nursing
2 - 3 years recent Case Management or nursing leadership
Utilization management, case management, or clinical nursing specialty
Current RN license in PA
Additional Scheduling Info: 80 hours biweekly, day shift
Additional Requirements: PA Act73 â“ Child Abuse Clearance Required
WellSpan Health is a nationally recognized integrated health system serving the communities of central Pennsylvania and northern Maryland. It comprises a multispecialty medical group, 1,200 physicians and advanced practice clinicians, a Level 1 Regional Resource Trauma Center, a regional behavioral organization, a homecare organization, six respected hospitals, more than 15,000 employees and 140 patient-care locations. We are transforming the health of our communities and educating medicine's next generation of providers and leaders.
Quality of Life in Lebanon, PA
Lebanon is a quaint city of 25,700 residents and was originally settled in 1720. The area features many sites on the National Register of Historic Places, including two railroad stations, the Chestnut Street Log House and high-spired churches. Other attractions include artists' studios and local crafts, Wertz Candies, a farmers' market, a community theater and Dreamscapes Watergardens. (Patient population: 140,000)
Equal Opportunity Employment
WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.