Job Details

JOB SUMMARY
The Case Manager RN utilizes advanced nursing skills and knowledge to comprehensively coordinate care for a defined patient
population to facilitate patients through the continuum of care. Coordinates all aspects of discharge planning and establishes a
safe discharge plan for assigned patients.
ESSENTIAL FUNCTIONS
Articulates the job's main responsibilities. This is not intended to be an exhaustive list of all essential functions or all duties
performed. The essential functions listed below and percentage of time may vary between departments and locations, and are
subject to change based on management discretion and organizational needs. Other responsibilities may be assigned at the
discretion of management to meet organizational needs.
• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. Advocates for the patient and
family throughout the entire episode of care. Functions as a resource to facilitate communication among the healthcare
team and patient/family. Facilitates patient progression throughout the patient’s hospital stay. Reviews patient length of
stay/barriers data to facilitate patients’ progression during Multidisciplinary Rounds and Escalation/Outlier meetings.
Reviews patients’ status daily to identify issues requiring priority interventions or attention which may impact the
established discharge plan. May facilitate daily patient Plan of Care Huddle Rounds functioning as the Patient
Progression Leader or supports the identified Patient Progression Leader. Monitors patient’s progress intervening as
necessary to ensure patient progresses efficiently. Proactively identifies and resolves barriers to patient care and/or
progression to discharge. Escalates unresolved barriers to Department Leadership.

Job Description

QUALIFICATIONS The requirements listed below are representative of the knowledge, skill, and/or ability required or preferred. Education - Required • of Nursing Experience - Required • case management or discharge planning experience Knowledge, Skills and Abilities - Required • Demonstrates effective use of conflict resolution skills as necessary to ensure timely resolution of issues. Demonstrates efficient prioritization and time management skills. Applies specific relevant medical necessity criteria for all patients to determine the appropriate patient status or continued need for hospital level of care (Center City). Documents appropriate medical necessity criteria level of care guidelines subset (InterQual)(Center City). Follows departmental procedures for Condition 44 downgrades, including medical record documentation, and informing patient and relevant department staff. Adheres to organizational policies and procedures, identified third party payer contract utilization management workflows and governmental payer processes. Applies initial DRG for all inpatients and document in the Care Advance (applicable hospitals). Completes an initial assessment to assess patient’s needs and resources for discharge planning. Establishes discharge plan including homecare services, transportation, post-acute facility placements. Ensures all Post-Acute authorizations are secured for patients discharge. Precept and mentor new staff members to their role and department. Meets with patient/family to assess needs to complete an initial Case Management Assessment per Department policy and procedure, then develops an initial discharge plan. Refers appropriate cases for Social Work intervention and involvement. Documents all relevant information in the Medical Record according to Department policies and procedures. Delivers the MOON to observation status patients within the required timeframe (Center City). Ensures appropriate patients receive the second copy of the CMS IM within 2 days of discharge (Center City). Facilitates patient transfers to other acute care hospitals. Communicates with identified Department staff to initiate and facilitate referrals and authorizations for post-acute care services and any medical necessity issues. Refers cases and identified issues to the Physician Advisor in compliance with departmenta

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Thomas Jefferson University Hospitals, Inc.

Primary Location Address

111 S 11th Street, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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