• Oversees the management of assigned patient populations across the continuum.
• Serves as a resource to the multidisciplinary/multi professional team to manage appropriate and safe patient care transitions.
• Works with departmental/physician/nursing leadership and the healthcare team for defined patient populations assisting to implement clinical pathways as appropriate.
• Drives patient satisfaction related to discharge planning and assures all patients are assessed for timely, appropriate and safe discharge planning.
• Serves as the primary information resource for case management staff, payors, and physicians, other healthcare team members, customers and regulatory bodies. (skill areas include regulatory requirements, pathway implementation/ i, ethics/ healthcare law, clinical skills, etc.).
• Conducts training sessions and workshops to educate case managers on best practices, policies, procedures, and relevant regulations. Provides ongoing education and professional development opportunities to enhance team members' skills.
• Identifies potential risks or barriers to effective case management, implements strategies to mitigate risks, and addresses any issues or concerns that may arise during the course of patient care/discharge planning.
• Educates others on case management responsibilities.
• Readily accepts responsibility for actions/discharge planning/appropriate utilization provided by assigned team.
• Assumes delegated activities from the manager/director/chief officer as requested.
• Addresses/resolves system problems impeding diagnostic or treatment progress.
• Proactively mitigates risk to patients with special focus on clinical discharge planning using the nursing process of assessment, intervention, implementation, and evaluation.
• Seeks consultation from appropriate disciplines/ departments/leaders as required to expedite care and facilitate safe discharge.
• Utilizes critical-thinking and demonstrates innovative thought.
• Ensures compliance with regulatory requirements, accreditation standards, and organizational policies. Reviews documentation to ensure accuracy, completeness, and compliance with legal and ethical standards.
• Identifies at-risk populations and establishes or identifies intervention to reduce risk and implements reporting procedures.
• Takes actions to achieve continuous improvement and understands continuous improvement methodology.
• Ensures that all elements critical to the discharge plan have been communicated to the patient/family and members of healthcare team.
• Assures appropriate documentation is completed on all patient groups timely, accurately and concisely.
• Responsible for coordinating seamless discharges.
• Drives initiatives to reduce excess days.
• Works to improve staff satisfaction through team building.
• Recognizes the importance of a dyad model utilizing social worker(s) as needed related to social work expertise.
• Is customer driven and focused, recognizing customers include but are not all inclusive of co-workers, providers, payers, nurses, and ancillary staff in addition to outside entities accepting patient referrals or working to provide supplies/equipment.
• Obtains necessary CEUs to maintain an active RN license.
• The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands

Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, occasional handling or working with potentially dangerous equipment, occasional exposure to bio-hazardous conditions such as risk of

radiation exposure, blood borne pathogens, fumes or airborne particles, and/or toxic or caustic chemicals which mandate attention to safety considerations, occasional working hours significantly beyond regularly scheduled hours, occasional work produced subject to precise measures of quantity and quality, occasional bending, occasional lifting and carrying up to 25 pounds, occasional climbing, occasional crawling, occasional crouching/stooping, occasional driving, occasional kneeling, occasional pushing/pulling, occasional reaching, occasional sitting, occasional standing, occasional twisting, and frequent walking. (occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more).