Registered Nurse RN Manager - Case Management - ACM CCM - Mon - Fri 8:00am - 5:30pm
Company: Northeast Georgia Health System
Location: Gainesville
Posted on: October 2, 2024
Job Description:
Job Category:Nursing - Registered NurseWork
Shift/Schedule:VariesNortheast Georgia Health System is rooted in a
foundation of improving the health of our communities.About the
Role:Job SummaryManages the day to day operations of the department
by supporting the case management and interdisciplinary healthcare
team in facilitating patient care through the continuum. Monitors
department activities to ensure optimum case management, including
education, competency and accountability of the licensed staff who
provide services to patients. Provides clinical oversight and
training in collaboration with the Department Educator and
leadership team to ensure staff competence, and develops core case
management standards and programs to facilitate optimal patient
care and effective transitions to an alternate level of care.
Responsible for identifying key performance indicators for the
department, ensuring all professional and organizational standards
are kept, and ensuing organizational and staff accountability. The
Manager will also be responsible for recruitment, hiring, staff
development, performance improvement, and progressive discipline as
necessary. In addition, program planning, budgeting, and longer
term strategic planning for the department in keeping with
organizational vision and goals are significant aspects of this
role. This position will come in contact with patients in the
neonate, infant, child, adolescent, adult, and geriatric age
groups. Employee performs clinical duties in accordance with
population specific guidelines and adheres to National Patient
Safety Goals as outlined in policy and procedures. Provides cross
coverage in all settings as required in the care continuum,
including weekend rotation.Minimum Job Qualifications
- Licensure or other certifications: Professional licensure or
national certification in health and human services. CCM (Case
Management Certification) or ACM (American Case Management
Certification) required within 18 months of date of hire.
- Educational Requirements: Bachelors Degree in Nursing or other
baccalaureate degree in Health or Human Services. Eligibility
requirements for certification: 12 months full-time case management
experience supervised by a certified case manager, or 24 months
full-time case management experience not supervised by a certified
case manager, or 12 months full-time supervisory experience as a
supervisor of individuals who provide Case Management.
- Minimum Experience: Five years of experience indirect patient
care and/or case management. Financial and management experience
required. Must be able to make independent decisions which directly
affect the institution both clinically/financially and
operationally. Maintains continuing education appropriate to case
management and sits for the national certification exam.
- Other:Preferred Job Qualifications
- Preferred Licensure or other certifications:
- Preferred Educational Requirements:
- Preferred Experience: ICD-10 and CPT coding preferred.
- Other:Job Specific And Unique Knowledge, Skills And Abilities
- Assertiveness and effective written/verbal communication
- Ability to affect change and positive relationship
building
- Flexibility, problem solving/organizational skills, and
promoting patient/family autonomy
- It is critical to have knowledge of funding resource, patient
services, and clinical standards and outcomes
- Demonstrate the ability to think 'outside of the box' and
consistently create new, and effective solutions to today's
problems and opportunitiesEssential Tasks And Responsibilities
- Participates in the initial and continuous development of the
NGHS Case Management function. Assumes responsibility in the
redesign and continuous quality improvement of the NGHS case
management function ensuring a balance between cost efficiency and
successful clinical outcomes. Participates in the development and
implementation of clinical standards of care/patient outcome
evaluation tools. Identifies and recommends information
systems/mechanisms for patient/resident tracking and comparative
data analysis. Explores opportunities for and provides
recommendations for organizational standardization. Participates in
identifying expanded use of and improvement management utilization
of NGHS continuum. Participates in identifying performance
standards for staff and incorporate into annual performance
evaluation.
- Coordinates and manages day-to-day operations for the case
management department and assumes full responsibility and
accountability for access and control throughout NGHS continuum.
Facilitates a managed care process that analyzes, orchestrates, and
delivers a medicine plan of care with a focus on accountability for
quality cost benefits consistent with payer, provider and consumer
expectations. Oversees daily performance of the case management
staff ensuring collaborative relationships with Physicians,
patients/families and other professionals focusing on optimal use
of and appropriate utilization within each phase of a continuum of
services. Assures case Managers serve as the patient's advocate to
obtain necessary funding, treatment alternatives, timeliness and
coordination of health services, and frequent re-evaluation of
progress toward goals. Maintains accountability for access control
and timely execution of patient movement through the continuum.
Works closely with the Physicians to identify and implement
clinical practice that improve patient outcomes and reduces
healthcare costs. Participates in data collection and identifying
clinical/financial/social factors that would advance/support the
practice of case management. Assures and is accountable for the
complete and accurate data tracking by staff through on-line
systems. Monitors "lightening rounds" patient/family conferences
and assures appropriate collaboration/integration of patient
services. Monitors appropriateness of Case Managers documentation
ensuring concise information that reflects patient's plan of
care.
- Ensures financial improvement performance of NGHS. Maintains
accountability for timely precert/recertification activity and
minimizes the organization's financial risk for penalty. Maintains
weekly inpatient unbilled accounts and meets organizational
financial targets. Assures concurrent financial management of the
patient's account focusing on a balance between cost and
reimbursement. Provides case-by-case contract negotiations where
indicated. Maintains responsibility for third party appeals
process. Provides annual financial enhancement to NHGS above and
beyond budgetary requirements.
- Participates with director in administrative responsibilities
for the department. Approves payroll and assures appropriate
tracking of employee records. Participates in the interviewing and
hiring process for vacant positions and assures appropriate staff
disciplinary action/documentation. Identifies staff educational
needs and arranges for appropriate education to maintain staff
competencies. Prepares work schedules and arranges daily coverage
on all areas of responsibilities.
- Consistently demonstrates a 'sense of urgency' in his/her work,
while mindful of the pillars and financial stewardship
opportunities.Physical Demands
- Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
- Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
- Vision: Moderate, Frequently 31-65% of time
- Kneeling/Stooping/Bending: Occasionally 0-30%
- Standing/Walking: Occasionally 0-30%
- Pushing/Pulling: Occasionally 0-30%
- Intensity of Work: Occasionally 0-30%
- Job Requires: Reading, Writing, Reasoning, Talking,
KeyboardingWorking at NGHS means being part of something special: a
team invested in you as a person, an employee, and in helping you
reach your goals.NGHS: Opportunities start here.Northeast Georgia
Health System is an Equal Opportunity Employer and will not
tolerate discrimination in employment on the basis of race, color,
age, sex, sexual orientation, gender identity or expression,
religion, disability, ethnicity, national origin, marital status,
protected veteran status, genetic information, or any other legally
protected classification or status.
Keywords: Northeast Georgia Health System, Warner Robins , Registered Nurse RN Manager - Case Management - ACM CCM - Mon - Fri 8:00am - 5:30pm, Executive , Gainesville, Georgia
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