Job Description
This is a preferred position and a panel style interview will be conducted. To qualify for an interview you must fill out a COMPLETE application. Any applications not completed in FULL and properly submitted will disqualify you from eligibility for interview.
This position will close to all applicants on January 6th, 2025 at 11:59 p.m.. Anticipated interviews to take place by January 27, 2025.
This position is Full time FTE: 1.000000 (80 hrs/per pay) 7:00 p.m.-7:30 a.m. Every Other Weekend.
Three (3) years of clinical experience as a Registered Nurse is required (please show this on your application).
Coordinates clinical patient services and ensures efficient resource utilization to assure optimal clinical quality outcomes by reviewing charts, assessing patients and patient families, evaluating care needs and recommending changes to patient care and physician treatment plans. Participates in quality assessment and continuous quality improvement activities. Complies with all appropriate safety and infection control standards. Performs all job duties and responsibilities in a courteous and customer focused manner according to the Hurley Family Standards of Behavior.Works under the general direction of Senior Nurse Case Manager or designee who reviews work primarily through conferences and reports. Position requires a self-directed approach to performing responsibilities and duties. Monitors Registered Nurses and other health care providers in the performance of achieving clinical outcomes and ensuring efficient resource utilization.
Responsibilities

1. Identifies patients for case management through screening mechanisms that are at risk for lengthy inpatient days, complex physiologic needs or repeat admissions due to chronic illness.
2. Conducts thorough and accurate case assessment of assigned patients/families within appropriate time frames, verifying appropriateness of admission and current clinical status.
3. Assures effective, efficient development of patient plan of care within appropriate time frame of admission. Addresses/resolves all variances from plan of care with workable alternatives.
4. Works collaboratively with Social Work Case Managers and others to facilitate communication of patient plan of care with all health care team members. As appropriate, consults and negotiates to reach more effective, efficient and integrated patient plan of care.
5. Facilitates coordination of treatments, tests and interventions in timely manner focusing on organization of consults, duplication of tests, and level of care, appropriateness, delays, and deviations from conditions to be treated. Monitors unit performance in achieving case management standards.
6. Identifies potential clinical complications. Facilitates prevention or resolution to achieve optimal outcomes.
7. Collaborates with Social Work Case Managers and others to identify potential or actual patient situations which require referrals or interventions from infection control, risk management, quality assessments, utilization management, financial services and/or other associated functions and promotes resolution.
8. Prioritizes and conducts timely review of patient progress in meeting clinical outcomes.
9. Collaborates with health care team/patient/family assisting with development of discharge plan to address clinical, psychosocial, environmental and financial needs to attain optimal outcomes along continuum of care. Ensures timely and appropriate discharge through utilization of appropriate resources.
10. Participates in patient care conferences. Organizes conferences as necessary.
11. Requests, in timely manner, assistance from physician advisor(s) as necessary to resolve issues and roadblocks appropriate for Medical Staff intervention.
12. Serves as role model, demonstrating high level of knowledge regarding case management, managed care, continuum of care services and resource utilization.
13. Identifies consistent clinical and operational bottlenecks. Facilitates resolution thorough established continuous improvement process.
14. Collects predetermined quality and resource utilization data. Completes generic screening processes as directed.
15. Completes all required documentation thoroughly and accurately within designated time frames. Monitors maintenance of accurate and descriptive documentation of patient's care. Identifies and participates in corrective action planning.
16. Maintains knowledge and understanding of current data related to length of stay, cost, clinical outcomes, physician practice patterns and so forth. Participates in data analysis. Recommends opportunities for cost savings or operational efficiencies and facilitates implementation of solutions.
17. Facilitates discharge planning process and works collaboratively with Social Work Case Managers and others to coordinate required post hospitalization services.
18. Collaborates regularly with Social Work Case Managers or others to facilitate the interdisciplinary care of patients.
19. Demonstrates self-directed commitment to professional growth. Maintains knowledge of research and progress in specific fields, thorough appropriate education and organizational activities.
20. Demonstrates effective judgment and ability to understand, react effectively and treat (if appropriate) unique needs of patient age groups served.
21. Performs other related duties as required, including new improvements and/or technology that relate to job assignment.
22. Proactively identify admitted patients and work with ED and Primary Care Physicians to assign the correct level of acuity to the admission.
23. Review details of admission and be able to apply intensity of service and severity of illness criteria as detailed in criteria reference ( e.g. interqual).
24. Be able to facilitate admission process by actively working to get a bed assignment, admission orders, transfer of the patient, nursing report, medication reconciliation and other duties that may expedite the transition of care.
25. Contact the Primary Care Physician to obtain admission orders on admitted patients. Must be able to discuss details of the admission orders while working collaboratively with the Primary Care Physician to make sure admission orders meet medical necessity.
26. Proactively communicate to the inpatient Case Managers, Social Workers, and the Nursing Team, any identified barriers to discharge, DME requirements, social issues and other issues that may prolong length of stay.
27. Communicate case review details of the admission to floor Case Managers, Social Work and the Nursing Teams.
28. Work with physicians to obtain documentation to support severity of illness, including primary and secondary diagnoses.
29. Have an understanding of the predicted course of care for each admission and be able to proactively manage the patient along this expected course.
30. Be able to work with the physicians to record an anticipated length of stay (LOS) for each admission.

Qualifications

• Graduation from an accredited School of Nursing.
• Three (3) years of clinical experience as a Registered Nurse
• Current knowledge of governing regulations, third party payor utilization, quality mandates, reimbursement requirements and standards associated with medical case management.
• Ability to work independently, set priorities and organize work while maintaining flexibility.
• Ability to effectively function under pressure and during stressful situations.
• Ability to compile, analyze, and evaluate data and prepare accurate reports from such data.
• Ability to effectively communicate in both oral and written modes.
• Ability to establish and maintain effective, harmonious working relationships with patients and their families, physicians and staff, external agencies and the public.
• Licensure as a Registered Nurse from the State of Michigan.