Case Manager - Full Time - Days

Why work for Nebraska Methodist Health System?
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Job Summary:

Location: Methodist Jennie Edmundson
Address: 933 E. Pierce St. - Council Bluffs, IA

Work Schedule: Monday through Friday 07:00 to 15:30; rotating weekend and holiday schedule

A Case Manager is a professional that ensures a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services is maintained to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost effective outcomes.

Ask your recruiter/hiring manager about the following incentives that may be available for this position:
• Shift differentials & other financial incentives
• Tuition assistance
• Academic sponsorship with Methodist College
• Free parking

Responsibilities:

Essential Functions

1. Promote positive relations when interacting with patients, visitors, families, physicians, customers and co-workers.

• Greet, smile and make eye contact. Introduce self by name.
• Volunteer to help co-workers and other employees.
• Respond quickly to patients and/or other peoples’ needs.
• Recognize and value input from health system personnel.
• Redirect hospital staff to demonstrate core values to promote a positive work environment.
• Serves as a role model to promote collaborative relationships.
• Know and demonstrate customer complaint management process.
• Communicate effectively to solve problems at the personal and unit level.
• Remain calm in difficult situations and effectively diffuse crisis and refer to appropriate supervisory levels as needed.

2. Clinical Care Coordination/Facilitation and Psychosocial management – coordinating multiple aspects of care to ensure the patient progresses. Properly identifies patient’s problems, psychosocial needs, environmental/barriers to care and coordinates the selection of appropriate services.

• Perform an initial/ongoing assessment of the patient, support system, and environment to determine factors that impact the patient’s ability to maintain the highest level of independence/care.
• Properly identify patient needs and coordinate care and services provided by the interdisciplinary team to meet the needs of patient and/or family through the episode of illness from pre-hospital and/or ED to post-hospital care.
• Provide timely referrals to care team (i.e., Social Work, Rehab, Wound Care, and Diabetes Educator), provide pertinent clinical information to facilitate discharge/inpatient admission arrangements and respond to discharge needs.
• Inform patient/family of services available and initiate services that are consistent with patient’s identified needs to maintain the highest level of independence.
• Effectively communicate patient/family needs and concerns as soon as identified to the physician and interdisciplinary team and assure appropriate utilization of hospital and community resources are offered and arranged.
• Provide immediate counseling of patients and family and effectively diffuse crisis and refer to appropriate services as needed.
• MJE Women & Newborns: Respond to admission education needs for Labor and Delivery, NICU, and Postpartum patients.  Facilitate all incoming scheduling needs from office. Chart review each event to confirm compliance and accuracy.

3. Continuity/Transition Management – transitioning of the patient to the appropriate level of care needed. Provides assistance with discharge planning – when needed, identifies appropriate agencies/facilities for patients requiring assistance at home or placement at another level of care.

• Maintain a level of expertise and current knowledge base on available community resources and services available.
• Provide and document a list of agencies available that serve the geographical area requested by the patient. Disclose to patient/family if the hospital has any financial interest with post hospital agencies.
• Ensure services provided are consistent with the patient’s identified needs. If applicable, provide referral to appropriate resources/agencies/facilities as soon as recognized, effectively communicating patient needs, provide access to electronic medical records and complete PASSR for nursing home admissions.
• Facilitate discharge needs or the return of patients to their previous facility, ensuring documentation and communication is effective.

4. Participate in the development of the discharge plan and assess the effectiveness to ensure barriers are addressed for safe discharge.

• MJE Case Management: Collaborate with physician, interdisciplinary team and patient/family to develop comprehensive, proactive discharge plans for all complex patients.  Participate in daily huddles/unit rounds and effectively communicate any barriers to discharge.  Facilitate discharge planning by documenting an accurate picture of patients discharge needs, services offered and any barriers to discharge or plan of care from being implemented or carried out.
• MJE Women & Newborns: Facilitate communication between CPS, legal, and surrogacy to meet discharge needs of newborns, intended parents, and birth parents.
• Follow up with patient/family to ensure needs and education are being met after discharge.

5. MJE Case Management: Utilization/Financial Management – Managing resource utilization and management.

• Collaborate with team to avoid unnecessary admission due to social reasons.
• Recognize payer source and what criteria insurance companies utilize.
• Provide daily evaluation of all observation/outpatient surgical patients criteria/guidelines for severity of illness and intensity of service that are potentially going to cross two midnights to ensure appropriateness of admissions/higher level of care needs. (Disease Specific)
• Communicate appropriate information to providers as requested.
• Serve as a gatekeeper for admissions. Provide real time evaluation of admission criteria/guidelines and continued stay for severity of illness and intensity of service to ensure appropriateness of admissions/higher level of care needs.
• Monitor and facilitates appropriateness of tests/procedures, consultations, treatment plans, and resource utilization.
• Discuss and review inquiries with Primary Care physician – including if appropriate asking for documentation of medical necessity of treatments.
• Anticipate barriers/variances to the delivery of care.
• Use critical thinking skills to provide sequencing of care activities to assure quality outcome for patients.
• Provide appropriate notices to patient after direction of physician advisor to include – HINN 10, 11, 12, Advance Beneficiary Notice of Noncoverage (ABN), IM, nonmedical waiver.

6. MJE Case Management: Performance & Outcomes Management – monitoring and intervening to achieve desired goals and outcomes for both the patient and the hospital. Participates in the development and implementation of community collaboration based on evidence-based practice that includes Methodist Jennie Edmundson Hospital core values, readmission efforts, decreasing length of stay efforts, and improving communication with the community.

• Assure that the core values, readmission, LOS, communication efforts are a community process and that the guidelines are well researched.
• Knowledge of community care efforts to decrease readmissions, appropriate ED utilization and admissions.
• Make appropriate referrals to community partners through Unite Us.
• Participate in community meetings to meet the needs of the community effort that benefit the patient and/or family through the episode of illness from pre-hospital to post-hospital care.
• Utilize Unite Us to document community resources and barriers of high-risk patients.
• Complete readmission worksheet and initiate readmission huddle to monitor and identify reasons for readmissions (Disease Specific)
• Facilitate the Chronic Pain Process and assist physicians in setting up plans of care for high risk or frequently seen patients. Utilize Chronic Pain policy.
• Participate in Chemo Huddles to monitor and identify appropriate utilization of resources and care being provided in correct setting.
• Collaborate with community partners to develop diagnosis-related protocols and standardized-based work.
• Provide concerns or barriers with community partners so communication will occur as soon as problems or concerns are identified.

7. MJE Case Management: Advocacy & Education – ensuring the patient has an advocate for needed services and any needed education. Promotes the education of all members of the interdisciplinary team, physicians/office staff, and patient/families.

• Provide ongoing education based on needs assessment – including use and understanding of admission criteria, issues related to funding, classification and types of admissions, and areas of patient choices and accountability.
• When current level of care is not appropriate, act as a resource to provider and patient for counsel, education and referral for access to the most appropriate care.
• Understand the principles of reimbursement as well as processes and procedures for securing authorization of admit status from payers.
• Educate and explain the rationale for determining admission and continued stay criteria.
• Communicate issues/trends (positive/negative) to Unit Nurse Manager and Supervisor as needed.
• Provide patient/family education and counseling about existing health problems and related care.
• Participate in new employee and student orientation.

8. MJE Case Management: Research & Practice Development – Identifying practice improvements and using evidence-based data to influence needed practice changes. Utilizes data bases from internal and external sources to demonstrate the effectiveness of case management in promoting quality patient outcomes and high patient satisfaction as well as efficient use of resources.

• Participate in timely and accurate data collection and assure that the data is reliable and valid measures will be obtained. (i.e. InterQual, Unite Us, Nebraska Health Information Initiative (NEHII), productivity studies, readmissions etc.)
• Assist in using the data collected to identify opportunities for improvement in hospital goals and outcomes.
• Participate in Performance Improvement process.

9. MJE Case Manager: Geriatric Coordinator -- responsible for planning, coordinating, and monitoring care for older adults to ensure they receive comprehensive, person‐centered services that address physical health, mental health, social, and environmental needs. The goal of the role is to promote independence, enhance quality of life, reduce avoidable hospitalizations, and support aging in place when possible.

• Elicit and document healthcare goals and treatment preferences for patients aged 65+, incorporating what matters most to them into the interdisciplinary care plan and discharge planning.
• Assist and collaborate with pharmacy to ensure medication reviews at admission, during stays/transitions, and prior to discharge; identify potentially inappropriate medications for older adults, reconcile medication lists, and work with providers to optimize regimens.
• Assist in coordinating the screening for older patients for frailty indicator,  including cognitive impairment or delirium risk, mobility limitations, and malnutrition, and coordinate timely interventions to prevent or mitigate decline.
• Assist in coordinating the assessment of social vulnerability in older adults and link patients and families to community or hospital resources to address identified needs.
• Serve as or support an age‑friendly care leader/champion or interprofessional committee to promote adoption and monitoring of age‑friendly protocols, ensure compliance with CMS measure domains, and drive continuous quality improvement in care for older adults.

10. MJE Case Manager: Diabetic Education Coordinator

• Assess patients with diabetes (or at risk for diabetes) for educational needs: review medical history, diet, medications, glucose monitoring practices, lifestyle and psychosocial factors to identify gaps in knowledge/skills.
• Deliver education in multiple formats to ensure understanding including direction on use of glucometers, insulin delivery, dietary planning, and prevention of acute/chronic complications.
• Coordinate with the Dieticians, hospital-based outpatient visits.

Schedule:

Monday through Friday 07:00 to 15:30; rotating weekend and holiday schedule

Job Description:

Job Requirements

Education

• Graduate of accredited Nursing Program required.
• Associate Degree in Nursing (ADN), Diploma, Bachelor of Science in Nursing (BSN) preferred.
• The Case Manager with a focus on diabetic education will need to complete 15 CEs per year (July 1 through June 30th) related to diabetes.

Experience

• MJE Case Management: 3-5 years current med-surg experience required.
• MJE Women & Newborns: 3-5 years current Labor and Delivery experience required.
• 3-5 years relevant clinical experience required.
• MJE Women & Newborns: Leadership and project management required.
• MJE Case Management: ED experience preferred.
• Discharge Planning, Case Management and Utilization Review experience preferred.
• MJE Case Management: 3-5 years current med-surg experience required.
• MJE Women & Newborns: 3-5 years current Labor and Delivery experience required.
• 3-5 years relevant clinical experience required.
• MJE Women & Newborns: Leadership and project management required.
• MJE Case Management: ED experience preferred.
• Discharge Planning, Case Management and Utilization Review experience preferred.

License/Certifications

• Current American Heart Association or American Red Cross Basic Life Support (BLS) strongly preferred at time of hire, required within 3 months of hire.
• Current valid Registered Nurse (RN) license, valid compact multistate license, or a temporary permit while awaiting licensure required.

Skills/Knowledge/Abilities

• Knowledge of case management principles, utilization review process, nursing principles, community resources, and adult education principles.
• MJE Women & Newborns: Knowledge of postpartum, labor and delivery and NICU.
• Skills in data collection and operating office equipment.
• Excellent communication skills, verbal and written.
• Ability to communicate effectively, develop collaborative relationships with a variety of professionals, and use critical thinking skills to problem solve.
• Demonstrates ability to maintain favorable relationships with physicians and health system personnel.
• Is self-directed and able to multi-task and prioritize work assignments.
• Able to deal with resistance and complex situations.
• Functions as an educator to physicians and health system personnel.
• Must be objective and logical.
• Ability to foster an attitude of teamwork and trust.
• Medium Work - Exerting up to 50 pounds of force.
• Not Related: - Electrical Shock/Static
• MJE Women & Newborns: Knowledge of postpartum, labor and delivery and NICU.
• Skills in data collection and operating office equipment.
• Excellent communication skills, verbal and written.
• Demonstrates ability to maintain favorable relationships with physicians and health system personnel.
• Is self-directed and able to multi-task and prioritize work assignments.
• Able to deal with resistance and complex situations.
• Functions as an educator to physicians and health system personnel.
• Must be objective and logical.
• Ability to foster an attitude of teamwork and trust.
• Medium Work - Exerting up to 50 pounds of force.
• Not Related: - Electrical Shock/Static

Physical Requirements

Weight Demands

Physical Activity

• Occasionally Performed (1%-33%):

• Climbing

• Crawling

• Kneeling

• Sitting

• Frequently Performed (34%-66%):

• Balancing

• Carrying

• Crouching

• Distinguish Colors

• Keyboarding/Typing

• Lifting

• Pulling/Pushing

• Repetitive Motions

• Standing

• Stooping/Bending

• Twisting

• Walking

• Constantly Performed (67%-100%):

• Grasping

• Hearing

• Reaching

• Seeing/Visual

• Speaking/Talking

• Climbing

• Crawling

• Kneeling

• Sitting

• Balancing

• Carrying

• Crouching

• Distinguish Colors

• Keyboarding/Typing

• Lifting

• Pulling/Pushing

• Repetitive Motions

• Standing

• Stooping/Bending

• Twisting

• Walking

• Grasping

• Hearing

• Reaching

• Seeing/Visual

• Speaking/Talking

Job Hazards

• Rare (1-33%):

• Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc.)
• Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)

• Occasionally (34%-66%):

• Chemical agents (Toxic, Corrosive, Flammable, Latex)
• Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)

• Explosives (Pressurized Gas)

• Frequent (67%-100%):

• Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)

• Equipment/Machinery/Tools

• Mechanical Moving Parts/Vibrations

• Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc.)
• Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
• Chemical agents (Toxic, Corrosive, Flammable, Latex)
• Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)

• Explosives (Pressurized Gas)

• Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)

• Equipment/Machinery/Tools

• Mechanical Moving Parts/Vibrations

About Methodist:

Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.

Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.