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Case Manager IV RN Gatekeeper-LGMC Case Management-Part Time in Lafayette, LA at Lafayette General Health

Date Posted: 12/13/2018

Job Snapshot

  • Employee Type:
    Part-Time
  • Location:
    1214 Coolidge Street
    Lafayette, LA
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    12/13/2018

Job Description

STATEMENT OF PURPOSE

Uses skilled intervention, clinical best practice knowledge and collaboration with the patient, physician and multidisciplinary treatment team to use hospital resources appropriately, ensure regulatory compliance and properly pace patients. Ensures the timely and seamless clinical transition of patients through medically appropriate levels of care.

MAJOR TASKS, DUTIES AND RESPONSIBILITIES

Represents LGMC to all our customers (patients, family members, significant other, physicians, etc.) as caring, concerned, compassionate and efficient healthcare organizations.

Supports LGMC's goals and objectives.

Create a working relationship with medical staff members, employees and management of LGMC, which allows for accomplishing the desired goals and objectives of LGMC and the Case Management department.

Ensures proper and complete documentation to support the placement and healthcare services provided to all patients.

Maintains a current understanding of changes and trends in standards of care, rules and regulations.

Monitors regulatory agencies for current rules and regulations

Identifies compliance and standard care issues

Conveys information to the appropriate internal and external stakeholders

Educate appropriate parties involved in issues

Ensure timely and appropriate outcomes while communicating with all individuals involved

Monitor changes to ensure competence, quality and compliance over time

Ensure proper and appropriate placement of all our patients. By working cooperatively with the medical staff, appropriate placement will be decided and the proper supporting documentation will be entered into the medical record.

Ensure appropriate post-acute placement of patients. Discharge planning will be started at the time of admit, and will be an ongoing multi-disciplinary collaborative effort.

Demonstrates the knowledge and skills necessary to provide care or support as appropriate to the age of the patients serviced in his or her assigned areas.

Makes timely and appropriate referrals to the appropriate discipline as identified for every patient.

Ensures proper, appropriate, and timely patient discharges and transfers to sub-acute and acute care units.

Serves as the resource for development of performance and outcome measures.

Assists in the development of structured methodologies based on research and scientific findings.

Represents LGMC to external parties, as necessary during the course of employment, so as to enhance the image of the organization.

Identifying new community resources, making changes to departmental lists and sharing as appropriate with coworkers.

Reports potentially libelous situation to the appropriate supervisors.

Be available on pager for ED nursing staff to assist with complicated discharge planning and assisting with nursing home placement.

Be available on pager to physician office personnel wanting to direct admit patients

Take initial orders

Assess proper status of patient

Scan initial orders

Notify admitting of the pending arrival

Once account created by admitting and patient arrives enter observation or inpatient orders into Cerner

19. Review all ED cases needing to be admitted

Determine proper status via InterQual

Determine proper level of care (CCU etc)

Check for proper order for status

Notify nursing of request to obtain bed assignment

Complete initial UR required clinical information (nights and weekends)

Enter status order into Cerner

20. Run OBS list at twice daily

Visit floor to assess OBS patient progress toward discharge

Perform usual CM tasks to manage these patients

Upon discharge or conversion to inpatient enter order into Cerner and enter exact observation hours into billing system

21. Via surgery schedule monitor for patients needing to be admitted. Assess for proper status and obtain order

Job Requirements

JOB REQUIREMENTS

Confidential Data:

Exposure and access to confidential information on a daily basis. Information includes medical records, insurance information, billing information and physician practices. Disclosure could be damaging to organization, our patient or our medical staff. Disclosure of this type of information may be misunderstood by the community and have a detrimental public relations effect on the organization.

Responsibility for Equipment and Information:

Continuous responsibility for items of extreme value. Requires close attention to avoid significant loss. Responsible for the care and security of computers, which will allow access to confidential information. Loss of the computer or any information may have a detrimental effect on the medical center.

Work should be complete with care, usually not checked or verified. Nature of work is such that errors could result in a financial loss to the medical center or patient.

Mental/Physical Demands:

Considerable mental concentration required. Any repetitive operations performed require intense concentration. Continuous sitting or walking with small amount of lifting or carrying.

Must be creative and resourceful

Must have strong analytical and problem solving skills

Must have the ability to organize work and meet deadlines

Must have determination

Must have good communication skills

Must have good educational skills

Working Conditions/Hazards

Average or periodical contact with conditions such as fumes, noises, chemicals, hazards and /or diseases. More than average noise due to the intermittent operations by several employees completing their duties in the same work location.

Requires flexibility in a work schedule.

Heavy computer usage.

Occasional travel may be necessary

Education, Training and Experience:

R.N. required and licensed in the State of Louisiana.

Prefer a minimum of 5 years of clinical work experience.

Knowledge of regulatory agencies

Extensive computer knowledge is required

Strong interpersonal and communicating skills

BLS CPR

Interpersonal Requirements/Independent Judgement:

Advance communication and interpersonal skills with all levels of internal and external customers. This includes, but is not limited to government agencies, third party payers, intermediaries, the medical staff, patient and families, clinical personnel support and technical staff.

Interpersonal skills to obtain and interpret information appropriate.

Requiring little direction while following definite work objectives, allowing for choice of methods.

Self development and Initiative:

Demonstrates self-directed learning and participates in continuing education for professional development.

Choice of methods or may refine existing methods to meet changing conditions and to achieve specific objectives. Requires above normal assertiveness to perform within time limits. Referring and/or enlisting suggestions regarding difficult situations to medical members, nursing staff, patients and their significant others.