The University of Texas Medical Branch Telephonic Nurse Care Manager - Care Management (DSRIP) DAYS in Galveston, Texas

Min Qualifications

RN with Bachelor's degree in Nursing and two years of inpatient experience in a hospital environment. Current license or valid permit to practice professional nursing in Texas.

JOB DESCRIPTION:

To screen assigned patient populations and, as needed, assess, counsel, educate, and provide discharge planning and problem solving; to ensure continuity throughout the episode of care; to provide timely and valid information to multi-disciplinary team, physicians and nursing related to discharges and follow-up care of patients. Acts as an advocate for patients and coordinates and collaborates with medical team to provide quality, cost-effective care, and to promote positive patient outcomes for UTMB patients.

Salary Range

The salary range for this position is $67,200 - $107,520/yr commensurate with experience.

The Pay Band for this position is NS22

Specific Job Related Duties

_ESSENTIAL JOB FUNCTIONS: _

  • Utilization Management

  • Ensure clear admit status and timely management of observation patients

  • Demonstrates knowledge of CMS guidelines and use of Local Coverage Determination (LCD) or inpatient and observation, CMS inpatient only list, and other payor guidelines as required

  • Demonstrates thorough knowledge in the application of InterQual criteria; Severity of illness (SI), Intensity of service (IS), Discharge screens (DS) SI, IS, and performs continued stay reviews for Medicare, Medicaid and self pay patients

  • Demonstrates skill in accurately entering required UM data. Works closely with denials/appeals coordinator

  • Elevate to department leadership all patients not meeting medical necessity criteria after impasse with attending physician

  • Creates final patient discharge disposition (closing of cases)

  • Level of Care

  • Ensure appropriate level of care/patient status

  • Facilitate clinical care progression of patient by multidisciplinary team throughout stay

  • Demonstrates knowledge of CMS guidelines and use of LCD for inpatient and observation, CMS inpatient only list, and other payor guidelines as required

  • Demonstrates appropriate application of InterQual LOC criteria to evaluate current patient care needs.

  • Elevate to department leadership all patients in an inappropriate level of care after impasse with attending physician

  • Documents avoidable days

  • Assessment of patients’ financial, emotional, physical, social, functional and health care needs

  • Demonstrates ability to assess discharge needs of all patients, and ability to prioritize patients by need, e.g. Medicare, high risk diagnoses, high risk for readmission, identified vulnerable patients

  • Identify readmission risk and target interventions to reduce risk for readmission

  • Define and recommend potential discharge plan

  • Utilize assessment to begin management of patient and family expectations regarding the plan of care

  • Care Coordination of Treatment Plan: Medical and Multidisciplinary

  • Participate in multidisciplinary rounds. Facilitates clinical care progression of multidisciplinary team in a timely and efficient manner

  • Facilitate Patient Care conferences based on patient/family needs

  • Manage patient and family expectations the plan of care

  • Contact appropriate ancillary department with any delays impacting care progression

  • Address incomplete, unclear medical plan of care with attending physician. If unsuccessful, elevate to department leadership, director or physician advisor as appropriate.

  • Length of Stay

  • Use basic knowledge of target LOS for patient diagnosis, actively monitor LOS timeframe and implement measures to achieve targets

  • Ensure timely intervention to prevent delays in service and transition of care

  • Document Avoidable Days

  • Identify, adjust and manage barriers to discharge

  • Elevate to manager all patients with an inappropriate length of stay after impasse with attending physician

  • Present Long LOS case

  • Discharge Planning

  • Demonstrate skill in educating patient/family and physicians regarding post acute options and addresses issues of choice

  • Demonstrate skill in developing clinically comprehensive discharge plans with patient, family, and applicable health care providers

  • Manage family expectations o Adjust and manage barriers to discharge

  • Collaborate with Social Worker daily o Arrange or facilitate identified discharge needs and services of patients

  • Communication

  • Demonstrates competency and skill in communication with patients, families, hospital staff, and visitors

  • Demonstrates skill in communicating with physicians the necessary documentation to demonstrate medical necessity

  • Demonstrates collaboration, professionalism and ability to work with all health care providers

  • Demonstrates ability to work with people of all social, economic and cultural backgrounds and is flexible, open minded and adaptable to change

  • Demonstrates capacity to manage “crisis situations”

  • Demonstrates skill and success in collaboration with Social Worker partner

  • Documentation

  • Demonstrates competency in timely and complete clinical, social, and functional patient assessment

  • Demonstrates timely and thorough documentation of proposed discharge plan A & B o Provides subsequent interactions with patient/family and appropriate physician discussions

  • Creates patient discharge disposition and collaborates with Social Worker to ensure documentation of final outcome in chart

  • Time Management

  • Demonstrates proactive, accurate, and timely assessment

  • Demonstrates timely response to request for case management intervention

  • Demonstrates skill in prioritizing case load for appropriate level of case management intervention

  • Demonstrates ability to coordinate and manage continuum of care

  • Demonstrates strong problem solving skills

  • Demonstrates timely documentation and closing of cases

  • Performance Improvement

  • Demonstrates support of the Care Management department and active participation in improving performance and achieving departmental goals

  • Demonstrates active participation in system, institutional and unit specific initiatives

  • Demonstrates understanding of the hospital’s mission, vision, values, culture and policies

  • Adheres to internal controls and reporting structure

Work Schedule

Mon. - Fri. 8-5pm

Preferred Education

RN with Bachelor's degree in Nursing

Closing Statement

#nurse

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or veteran status. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.

Full/Part Time: Full-Time

Regular/Temporary: Regular

Job Title: Telephonic Nurse Care Manager - Care Management (DSRIP) DAYS

Job ID: 53055

Location: Galveston

Business Unit: HOSPT