Nurse Manager, Complex Case Management,

POSITION SUMMARY:

As a member of the Case Management leadership team the Nurse Manager for Complex Case Management and the ED, manages complex patient concerns elevated by frontline case managers. This individual will identify trends with complex patients using databases, observations of workflows and communications with intradisciplinary teams. He/she consolidates information and presents to hospital leadership and works closely with key stakeholders to reduce barriers to discharge, reduce length of stay and increase key BMC performance measures for all complex inpatient discharges including patients experiencing homelessness and within the conservator/guardianship process.

The Nurse Manager for Complex Case Management is a registered nurse who functions as a patient care provider, supervisor and clinical resource for staff. She/he implements management and clinical activities to ensure that the nursing process is operationalized utilizing Standards of Care/Standards of Practice. The primary responsibilities include ensuring the provision of patient care consistent with department/hospital and regulatory standards and is accountable for organizing and assigning patient caseloads to case managers in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources.

Position: Nurse Manager

Department: Complex Case Management and ED

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

1.0 Performs management duties in collaboration with the nurse director to achieve and maintain quality services and positive employee relations.

1.1 Assumes overall unit management within established policies, procedures, labor and supply budgets in the absence of the nurse director.

1.2 Supervises (hires, evaluates, and disciplines) all RN and non-RN staff according to established personnel policies, procedures and union contracts.

1.3 Initiates and facilitates problem solving by timely identification and communication of staff and patient care issues and solutions to nurse director.

1.4 Assures that staff schedules are completed and posted in accordance with nursing department policies, procedures and union contract requirements.

1.5 Acquires, maintains, and utilizes knowledge of current labor contracts and personnel policies and procedures, initiates timely and appropriate management interventions, inclusive of coaching, counseling and progressive discipline. Works collaboratively with Human Resources/Labor Management staff as needed.

1.6 Conducts independent investigation of employees incidents involving clinical practice issues including review of employee personnel file, discipline record and evaluations. Imposes appropriate disciplinary action when needed.

2.0 Promotes and facilitates staff’s professional development to ensure the unit provides quality nursing care.

2.1 Promotes staff development and clinical competency by facilitating staff attendance of unit in-services, appropriate outside conferences, and department committees.

2.2 Promotes own professional development by attendance at conferences with a management/clinical focus.

2.3 Develops staff assignments for patient care taking into consideration individual staff abilities and learning needs.

2.4 Works collaboratively with the nurse director/clinical instructor to establish, facilitate and coordinate a preceptor program.

3.0 Participates in quality improvement activities and on committees to ensure that Standard of Care/Practice are evaluated and met.

3.1 Completes unit based quality improvement/risk management projects in collaboration with the nurse director.

3.2 Participates in assigned committees and communicates timely information to nurse director and staff.

3.3 Facilitates unit based, approved research projects.

3.4 Promotes practice that is in compliance with appropriate statues and regulations (i.e., DPH, Joint Commission, OSHA, etc.).

4.0 Coordinates clinical activities to ensure safe and efficient functioning of the unit based on patient needs.

4.1 Collaborates with appropriate team members to promote a smooth flow of patients through the hospital system.

4.2 Demonstrates the knowledge and skills necessary to promotes care appropriate to the age groups of patients served.

4.4 Promotes and maintains effective professional relationships with all healthcare team members to ensure that patient care issues are addressed in a timely manner.

4.5 Acts as a clinical role model to staff through provision of direct patient care in accordance with appropriate department policies and procedures.

4.6 Promotes the Nursing Department’s mission, professional practice model, and Magnet culture.

Other duties Interprets/translates for patients/families/visitors when needed and when conversant in his/her native language. Utilizes hospital's Values as the basis for decision making and to facilitate the division's hospital mission. Follows established hospital infection control and safety procedures. Performs other duties as needed.

Case Management related responsibilities

Works collaboratively with intradisciplinary teams on key taskforces to reduce barriers for complex patients and improve BMC metrics.

Serves as subject matter expert to staff responsible for executing complex care management functions; which includes providing direction and guidance for managing high-risk complex cases.

Interfaces with and educates physicians and other stakeholders regarding the goals and objectives of care management and roles/responsibilities of staff.

Analyzes and evaluates the effect of care management on quality outcomes, fiscal parameters, customer satisfaction, and system operations and implements strategies to resolve system, performance, and patient variances.

Communicates with and seeks feedback from stakeholders regarding the implementation of case management programs and activities.

Conducts clinical performance improvement audits, which assesses quality of services against key indicators, and provides timely feedback to personnel.

Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.

Subject matter expert demonstrating proficient knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.

Analytical abilities necessary to organize, supervise, and evaluate the work of others, to develop, interpret, implement, evaluate policies, procedures, standards, budgets, and to utilize current nursing practice concepts and theories.

Stays current with BMC, State and Federal grants, protocols and regulations regarding complex care population.

Maintains detailed criteria for inclusion and exclusion in the complex case management caseload.

Proactive in planning complex discharge and engages in creative problem solving with intradisciplinary teams, internal and external to BMC.

Meets regularly with care management leadership and relevant stakeholders, to triage program issues appropriately and elevate key issues and barriers to senior leaders

Facilitates interdisciplinary consultation on patient’s behalf through participation in rounds, family meetings, team meetings and clinical reviews

Provides expertise and clear recommendations on safe discharge plans for at-risk homeless patients. Helps coordinate implementation of long-term care plans.

Responsible for networking with our community partners to better leverage delivery of care for complex patients post discharge

Analyzes issues and trends in bed management and utilization of resources and strategizes to address them and follow through on proposed solutions.

Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials, and appeals.

Uses data to drive decisions and plan/implement performance improvement