RN Supervisor, Utilization Review/Case Management Palisades Medical Center
Company: Hackensack University Medical Center
Location: North Bergen
Posted on: June 12, 2021
Supervises assigned staff to ensure that all case management
processes are in order; including coordinating patient activities
to ensure that care meets evidence-based practice standards, and
regulatory/payor requirements. The role integrates and coordinates
utilization management, care coordination, discharge planning
functions and performance improvement activities for the case
managers. The Supervisor Case Management is accountable for the
department's designated staff caseload and plans effectively in
order to meet staffing needs, manage the length of stay, and
promote efficient utilization of resources; specific functions
within this role include: a. Facilitation of the collaborative
management of patient care across the continuum, intervening as
necessary to remove barriers to timely and efficient care delivery
and reimbursement. b. Application of process improvement
methodologies in evaluating staff's documentation. c. Coordination
of communication with physicians, nursing, and staff of ancillary
departments. d. Evaluation of care provided against the Length of
Stay. e. Collaboration with Admission Services to ensure accuracy
of patient demographic and insurance information. f. Communication
with patients and their families around medical plan of care and
discharge plan, in difficult cases. g. Ensure that
multi-disciplinary care conferences and afternoon 'huddles' are
occurring in conjunction with Nursing. h. Supervises the staff with
all case management process, including LOS, throughput, patient
flow and denials and appeals follow up. i. Responsible for staff
productivity and ongoing education. j. Responsible for disciplinary
action and performance improvement plans when appropriate in
conjunction with Manager of Case Management.
- Leadership a. Troubleshoot any issues pertinent to case
management to assist in managing LOS and patient throughput. b.
Provides direction to the interdisciplinary team as needed in
difficult cases. c. Being able to obtain, interpret and present
metrics related to case management to leadership and staff at
Hackensack UMC. d. Attend key meeting and present the information
about existing case management processes. e. Develops the
performance enhancement plan of the case manager, documents
performance provides performance feedback, evaluates the work of
the employee and provides reward and recognition for proper and
efficient performance. Determine areas of opportunities and suggest
process improvement. f. Documents causes for disciplinary
action/counsels and coach's staff when needed and makes formal
recommendations for disciplinary actions. Responds to formal and
informal employee grievances and prepares written responses as
required. g. Participate in departmental preparation for JACHO. 2.
Coordinates/facilitates patient care progression throughout the
continuum. a. Works collaboratively and maintains active
communication with physician, nursing, and other members of the
multidisciplinary care team to effect timely and appropriate
patient management. b. Identifies and resolves delays and obstacles
to discharge in a proactive manner. Collaborates with medical
staff, nursing staff, and ancillary staff to eliminate barriers to
efficient delivery of care in the appropriate setting. c. Seeks
consultation from appropriate disciplines/departments as required
to expedite care and facilitate discharge. d. Utilizes advanced
conflict resolution skills as necessary to ensure timely resolution
of issues. 3. Quality Actively participates in clinical performance
improvement activities by: a. Assisting in the collection and
reporting of indicators tracking efficiency of case management
processes. b. Use of data to drive decisions and plan/implement
performance improvement strategies related for assigned staff,
including fiscal, clinical, and patient satisfaction data. c.
Collection of delays in service data and data for specific
performance and/or outcome indicators as determined by MCG, EPIC
and BI reports.. d. Collaborates with Physician
Advisors,/Hospitalist in needs related to Case Management and
difficult cases. e. Attends in-service programs. f. Participates in
initiatives to improve HCAPPS scores. g. Collaborates with social
work for a seamless transfer from acute to post acute care. h.
Develops the performance improvement plan for the case manager,
based on audits of the particular case manager. i. Counsels and
coaches staff. j. Participates with MCG Annual training 4. Service
a. Provides MCG training to the Physician advisors, Medical staff.
b. Reinforces MDR process within the Medical Center. c. Ensures
that staff have MCG training modules to review as needed. 5. Growth
a. Uses MCG Guidelines as a coaching tool to aid
physicians/hospitalist in appropriate placement of patients.
Consults with Physician Advisor as appropriate. b. Provides
training for staff along with technical support as needed.
Monitoring of caseloads for accuracy in the application of the MCG
guidelines and identifying areas for process improvement in order
to support the case management team. c. MCG yearly
training/implementation of IRR testing and compliance. 6. Adhere to
the Medical Center's Organization Competencies and the Standard of
Education, Knowledge, Skills and Abilities Required: 1. Minimum
of 4 years experience in Case Management in an acute care setting.
2. Excellent interpersonal communication and negotiation skills. 3.
Strong analytical, data management and PC skills. 4. Current
working knowledge of discharge planning, CMS regulations, case
management, performance improvement, and managed care
reimbursement. 5. Understanding of pre-acute and post-acute venues
of care and post-acute community resources. 6. Strong
organizational and time management skills, as evidenced by a
capacity to prioritize multiple tasks and role components. 7.
Ability to work independently and exercise sound judgment in
interactions with physicians, payers, and patients and their
families. 8. Ability to rotate on weekend/ holiday on call.
Education, Knowledge, Skills and Abilities Preferred: 1. Bachelor's
degree in nursing (BSN). 2. RN with 4 years case management
experience in acute care setting. 3. Knowledge of INDICIA, EPIC and
MCG. Licenses and Certifications Required: 1. AHA Basic Health Care
Life Support HCP Certification. Licenses and Certifications
Preferred: 1. NJ State Professional Registered Nurse License. 2.
Certified Case Manager.
Keywords: Hackensack University Medical Center, Brick , RN Supervisor, Utilization Review/Case Management Palisades Medical Center, Other , North Bergen, New Jersey
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