Main Function

Reports to the Director Care Management or designee. Provides coordinated care support to Physician leadership and Clinical Manager(s) of respective services. Makes daily rounds and collaborates with the clinical healthcare team across the patient care continuum to include pre-admission and post hospital discharge. Participates in the oversight of the progress of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization with Care Port to enhance the quality and cost effectiveness of patient care and prevent readmissions.

Education/Experience

Graduate of a School of Nursing (BSN preferred) with current license to practice as a Registered Nurse in the State of Rhode Island or in the nurse’s primary state of legal residency if that state is a member of the Nurse Licensure Compact. Five (5) years of clinical experience that includes recent experience with case management, patient navigation, case management, utilization review or discharge planning is strongly preferred.

Must exhibit strong interpersonal skills as well as a collaborative approach and style of communication in order to interact successfully on a daily basis with a wide and diverse population of both health care providers, patients and their families.

Familiarity with InterQual™ / MCG care management criteria is required.

Must demonstrate knowledge and skill necessary to provide care to patients throughout the life span, with consideration of aging processes, human development stages and cultural patterns in each step of the care process.

A basic proficiency in the use of Microsoft office software programs including email, Outlook calendar and basic keyboard skills are also required.

Center Case Management (CCM) ® board certification or Accredited Case Manager (ACM ™) is highly desirable.

Interrelationships:

Patient Contact / Age Groups Served:

Check all that apply (X) Adolescent (X) Adult (X) Elder ( ) N/A

Internal Contacts: Individual contact with all levels of hospital employees, clinical care teams, physicians, patients, and families/significant others.

External Contacts: Required to communicate with Post-Acute Care Facilities and agencies, Durable Medical Equipment and Ambulance companies, managed care (insurance) personnel and physician office.

Working Conditions, Physical Environment and/or Safety Requirements: Works in a well-lighted and well-ventilated area. Must meet annual safety training requirements relative to a safe work place. Must meet health-testing requirements. Frequent patient contact requires adherence to standard precautions at all times. May be required to lift heavy objects weighing 25 pounds from time to time.