St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
The RN Care Manager coordinates the overall progression of care, resource utilization, and discharge planning for designated patient populations across the continuum of care. The RN CM works with the providers, social workers and multi-disciplinary care teams to facilitate the achievement of desired patient, quality, and financial outcomes.
JOB DUTIES AND RESPONSIBILITIES:
Assesses the patient’s needs, goals, and barriers in relation to the patient’s clinical condition, psychosocial environment, and socioeconomic resources.
Collaborates with the multidisciplinary team to plan, implement and evaluate the patient’s plan of care via daily rounds.
Collaborates with the patient, family or other caregivers, and multidisciplinary team to design a discharge plan respective of the patient’s needs and goals. Re-evaluates and revises discharge plan of care as additional information is obtained or goals change.
Facilitate communication among all treatment team members.
Manages length of stay by proactively identifying and mitigating issues and barriers to care and a successful discharge plan; monitor GMLOS, daily LOS.
Monitor risk assessment via LACE+ and implement discharge interventions accordingly.
Identify patients with an unplanned readmission and complete root cause analysis.
Collaborate with Outpatient Care Managers to identify patients for handover and post discharge follow up.
Assures compliance with regulatory and payer source requirements.
Issues applicable state/federal regulatory notices as applicable ie.) Important Message from Medicare, Medicare Outpatient Observation Notice, Bundle Payment Care Initiative notification.
Collaborates with the business office, utilization review staff, denials management and physician advisors in order to communicate medical necessity/insurance information to the multidisciplinary team.
Actively addresses and monitors resource utilization and documents avoidable delays/days.
Arrange for post discharge needs as appropriate, including but not limited to, DME, HHC, transportation, prescriptions, and follow up appointments.
Uses electronic systems to accurately document care management functions.
Maintains confidentiality of all materials handled within the Network/ Entity as well as the proper release of information.
Complies with Network and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements.
Demonstrates/models the Network’s Service Excellence Standards of Performance in interactions with all customers (internal and external).
Demonstrates Performance Improvement in the following areas as appropriate: Clinical Care/Outcomes, Customer/Service Improvement, Operational System/Process, and Safety.
Demonstrates financial responsibility and accountability through the effective and efficient use of resources in daily procedures, processes and practices.
Complies with Network and departmental policies regarding attendance and dress code.
Demonstrates competency in the assessment, range of treatment, knowledge of growth and development and communication appropriate to the age of the patient treated.
PHYSICAL AND SENSORY REQUIREMENTS:
Sitting for one to two hours at a time, walk on all surfaces for up to five hours a day, and climb stairs. Must be capable of driving a car and have the ability to finger and handle objects frequently. Occasionally firmly grasp, twist, and turn objects with hands and fingers. May be required to lift, carry, push, and/or pull objects weighing up to 75 pounds. Occasionally stoops, bends, squats, kneels and reaches above shoulder level. Staff must have the ability to hear as it relates to normal conversations and high and low frequencies and to touch as related to telephone and computer keyboard.
Graduate of professional nursing program. Registered Nurse with current license to practice in the State of Pennsylvania or seeking Pennsylvania licensure through reciprocity. NJ RN licensure required for Warren Campus. Advanced degree preferred. BSN required or obtained within 3 years of hire, MSN and/or Case Management Certification preferred.
TRAINING AND EXPERIENCE:
Extensive clinical knowledge. 3-5 years of acute care experience. Previous care management experience is preferred. Experience in the use of InterQual/Milliman criteria preferred. Ability to establish and maintain collaborative and effective working relationships required.
St. Luke’s University Health Network (SLUHN) is a non-profit, regional, fully integrated, nationally recognized network providing services at seven hospitals and more than 200 sites, primarily in Lehigh, Northampton, Carbon, Schuylkill, Bucks, Montgomery, Berks and Monroe counties in Pennsylvania and in Warren County, New Jersey.