Case Manager RN -Kennedy Emergency Dept

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The Case Manager is responsible for ensuring patient progress and meeting and facilitating a safe and sustainable transition plan. Collaborates with Physician and Interdisciplinary Team to determine plan of care, treatment, estimated LOS, and likely discharge disposition. Ensures patient progress through clinical milestones and adjusts the targeted discharge day as indicated. Collaborates with Interdisciplinary team members to identify effective strategies, resolve barriers, and improve processes. Facilitates communication among physicians to advance plan of care. Monitors and documents avoidable days, plans medical discharge needs, and ensures data entry accuracy. Supports the efforts of HIM and Patient Accounts. Provides hand-off communication to acute care staff, directs patient assignments, leads consultation regarding bed placement, and diverts unnecessary admissions from ED to community-based providers. Identifies recidivistic patients, works to decrease ED over-utilization, and creates/update Patient Specific Action Plan.

Roles Responsibility
Develop and coordinate Discharge Plan, Integrate patient's story into multidisciplinary plan of care, Coordinate patient care progression, Collaborate across multiple disciplines, Lead Care Coordination Rounds, Participate in clinical performance improvement activities, Build positive working relationships, Conduct team meetings for unplanned readmissions, Facilitate patient's transition through levels of care
Desired Qualification
Type
Permanent
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