#ALDIND

Shift: M-TH 7A-5P, no on call, no weekends

Hospice or palliative care experience preferred but not required. Be able to deliver end of life information factually and compassionately. Epic experience preferred but not required.

Good understanding of end stage disease, great communication skills. 

Job Summary: The Case Manager (RN) provides case management services to patients and families. This role identifies patient discharge and transition of care needs and coordinates discharge planning activities. The case manager works collaboratively with the patient and interdisciplinary team to develop a safe discharge plan that minimizes the risk of hospital re-admissions.

Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom.

Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Certified Case Manager (CCM), preferred.

Work Experience: Minimum 3 years of clinical experience as a registered nurse. Case management or discharge planning experience, preferred.

Knowledge, Skills and Abilities: Superb customer relations, telephone etiquette, and communication skills. Ability to work independently with minimal supervision. Demonstrated sound clinical knowledge of the medical surgical patient. Ability to be highly organized in a fast-paced environment. Ability to organize and prioritize work in an effective and efficient manner. Working knowledge of Microsoft 365 with basic computer skills.

Essential Functions and Responsibilities: Plans patient care with physicians and other members of the healthcare team. Ensures the care plan and the discharge plan are consistent with the patient's clinical course, continuing care needs, and covered services. Identifies and proactively identifies potential barriers to discharge. Participates in multidisciplinary patient rounds. Coordinates the planning discharge processes in coordination with the health care team, patient, and caregivers. Evaluates patient progress towards established clinical/functional goals. Initiates efficient coordination of discharge from the acute care setting. Obtains authorization from payers from post-acute care services. Arranges provisioning of care to the appropriate settings (home health care, rehab, skilled nursing facility). Assists in the coordination of hospital-to-hospital transfers. Evaluates re-admission reasons to ensure discharge activities are handled accordingly. Tracks avoidable days, analyzes trends, and reports findings to leadership.

Decision Making: Independent judgement in making decisions involving non-routine problems under general supervision.

Working Relationship: Works directly with patients and/or customers. Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

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