Summary
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Provides guidance and oversight to all Nursing staff in the Case Management division of the Care Coordination Department.
- Acts as a resource, provides feedback, and ensures a systematic collaborative approach to provide and coordinate healthcare services to a defined population. The framework includes five components: assessment, planning, implementation, evaluation, and interaction.
- Promotes, develops, and supports Nursing values, practice, and leadership in healthcare.
- Provides supervision to the case management team as well as direct intervention and consultation upon request/referral from patients, families, healthcare professionals, and other community members.
- Collaborates with patients, families, and staff with the goal of decreasing fragmentation and duplication of care and enhancing quality, cost-effective clinical outcomes.
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Works in partnership with Social Work Supervisor, Care Transitions Supervisor, Manager of Care Coordination and Director of Care Coordination for positive outcomes
Essential Duties and Responsibilities
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Supports and promotes the mission and values of Covenant Health Ministry.
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Participates in initiatives to promote clinical and professional collaboration within the hospital, Integrated Management Group, system-wide and in the community.
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Works collaboratively with the Director and other members of the Care Coordination team to provide a seamless transition across the continuum of care.
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Assists with development of policies, procedures, competency, and orientation documentation and acts as preceptor when needed
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Provides supervision of nursing staff in Case Management
- Completes performance evaluations and stay interviews within determined timeframes
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Facilitates and participates in peer review of Case Management staff to assure quality in practice and completes staff evaluations when due.
- Assists with disciplinary matters involving the Case Management staff in collaboration with the Director.
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Responsible for assuring that there is sufficient staff coverage to meet the needs of patients in collaboration with the Director.
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Ensures that Case Management and staff maintains/enhances professional development.
- Disseminates information critical to job performance.
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Provides clinical supervision to professional staff and consultation regarding cases presenting difficult issues as needed.
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Participation in leadership development opportunities.
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Performs initial and ongoing assessment prioritizing case management services by determination of catastrophic, high risk and high chronicity injuries and illnesses.
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Perform ongoing evaluation and critical analysis of the patient’s progress to ensure that the patient’s needs are being delivered in the most appropriate setting and in a timely manner.
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Collaborate with the interdisciplinary team to evaluate objectively and critically all information related to the current or proposed treatment plan to identify potential barriers, clarify, or determine realistic goals and objectives, and seek appropriate alternatives for the patient.
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Serves as a patient advocate to ensure quality outcomes
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Identifies and facilitates patient/ family conferences as needed
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Respects the dignity and confidentiality of the patient in all verbal/written information and communication.
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Supports the role of the clinical primary nurse and utilizes their clinical expertise and input in the care of the patient.
- Represent the patient’s interests by advocating necessary funding by providing clear and timely reviews to the payors, appropriate treatment alternatives, timely coordination of health services, and frequent re-evaluation of progress and goals.
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Plans, communicates, and collaborates with the patient and/or family, the provider, and the interdisciplinary team to develop the optimum post-hospitalization care plan utilizing the available resources to promote a quality, cost-effective and timely discharge.
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Initiates referrals to non-acute facilities, home care providers and all post-hospitalization services in a timely manner to assure continuity of care and prevent delays in discharge.
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Communicates clearly and accurately to the post-hospitalization providers of care and service, about the patient’s clinical status and discharge needs.
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Provides updates to the physician, patient and/or family with any changes to the original discharge plan of care while ensuring the plan is safe, appropriate, acceptable, and feasible.
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Applies relevant CMS regulations and discharge guidelines to ensure compliance with Medicare Conditions of Participation.
- Identifies opportunities for improvement in processes and quality of care and communicates findings to the Director of the department and colleagues.
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Identifies high risk patients & families and makes referrals Quality and Risk Management
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Actively participates in Performance Improvement.
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Collects and analyzes data that reflects process improvement activities for Care Coordination
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Maintains current knowledge of DNV & CMS regulations.
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Demonstrates a commitment to maintain competencies and participates in those activities, which contribute to the ongoing development of self, the profession, and other members of the health care team.
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Annual goals are achieved.
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Acts as a role model for other case managers.
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Maintains current knowledge of organizations’ policies and procedures.
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Completes all mandatory learning assignments within specified timeframes
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Case Management representation on hospital committees.
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Performs various assignments associated with the work of the department as assigned by the Director of Care Coordination
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Demonstrates initiative, decision-making skills and an ability to work independently and with flexibility.
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Coordinates special projects as requested
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Other duties as consistent with this role
Job Requirements
Job Knowledge and Skills
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Excellent communication skills
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Computer skills
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Strong interpersonal skills enabling effective team collaboration
- Positive attitude
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Strong organization and time management skills
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Ability to work independently
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Ability to work remotely as needed
Education and Experience
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Registered Nurse licensed in New Hampshire required
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Case Management and/or Utilization Management experience required
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Certification as CCM and/or ACMA-RN preferred
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BLS/CPR, AED Certification required
An equivalent combination of education and experience which provides proficiency in the areas of responsibility listed above may be substituted for the above education and experience requirements.
Working Conditions/Physical Demands
Must possess the physical and mental abilities to perform the tasks normally associated with this position that involves a combination of sitting, standing, walking, bending, stooping, and reaching. Occasional lifting/carrying up to 25 lbs. Some stress related to high level of responsibility for quality care.
Americans with Disabilities Statement
Must be able to perform all essential functions of this position with reasonable accommodation if disabled.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Covenant Health reserves the right to modify position duties at any time, to reflect process improvements and business necessity.
Standard of Business Conduct
Every St Joseph Hospital employee is required to abide by the Standards of Conduct and to report any activity that appears to violate the Standards of Conduct.