Complex Case Manager

Position Purpose

This position is responsible under the supervision of the department manager to collaboratively plan, coordinate, and implement a safe discharge for the patients in the hospital who are identified to have complex and time-consuming discharge planning needs.

The Complex Case Manager serves as a resource to case managers and / or social workers working with complex to discharge patients.

The Complex Case Manager carries an assigned caseload of complex patients identified by length of stay or time intensity outlier designation.

This position analyzes data to understand the causes and corrective actions for this subset of patients and is required to routinely interface and collaborate with hospital leadership, community partners, and patients / families.

Nature and Scope

• Focuses on the most complex, time-consuming discharge planning issues / patients, once determined that the needs far exceed the routine discharge planning process.
• Assigned patients from those exceeding the hospital’s self-selected extended stay threshold.
• Coordinates the discharge planning process for complex patients, including those with greater psychosocial acuity, or having time-sensitive needs.
• Serves as a resource to any Social Worker or RN Case Manager who has a complex patient requiring intensive discharge planning.
• Collects and analyzes data regarding referrals and complex cases.
• Utilizing an interdisciplinary team approach, this position acts as a consultant and educator on matters referring to alternative levels of care and managed care issues.

Through collaboration, this position provides optimal patient care through assessment, planning, implementation, and evaluation of neonatal, pediatric, adolescent, adult, and geriatric patients, and families.

• Provides information regarding length of stay and reimbursement issues to physicians as needed to ensure the appropriate and timely disposition of the client to the next level of care.
• Meets routinely with hospital leadership to engage and collaboratively resolve system level concerns, while managing individual caseloads These meetings include leadership representation from Case Management, Physicians, Nursing, Risk Management / Legal, Government Relations, Hospital Administration, Post Acute, etc.
• Monitors and documents the progress of the plan, making revisions as needed, to assure a smooth transition to the next level of care at the time of discharge.
• Provides regular updates (as least weekly) of complex discharge planning activities of assigned patients to the complex discharge planning committee members.
• Prepares a weekly executive summary on the status of the patients who are exceeding the hospital’s self-selected extended stay threshold, including barriers and ongoing efforts to executive discharge.
• Utilizes independent judgement to determine appropriate use of department patient assistance funding for group home placement, medications, durable medical equipment, to assist in coordinating safe and appropriate discharge for patients (leadership final approval required).
• This position has the authority to review and evaluate each case; establish work priorities; and differentiate between services the hospital can provide and those services, which can be provided more appropriately by the community.

KNOWLEDGE, SKILLS, & ABILITIES :

• Excellent documentation and communication skills.
• Ability to complete thorough discharge planning assessment, determine appropriate level of care for post-acute needs, determine length of stay related to patient’s condition, and coordinate the implementation of the discharge plan.
• Requires knowledge and understanding of medical terms.
• Ability to function in crisis situations, apply independent and mature judgment, maintain professionalism, and establish priorities.
• Must be able to independently apply critical thinking skills to find quick and appropriate solutions and must be comfortable escalating to leadership when services or care are not delivered efficiently or appropriately.
• Must have confidence to present full details of a patient’s case to the interdisciplinary team, identifying the barriers to discharge and next alternative options to consider in order to facilitate appropriate and timely discharge.
• Must respect beliefs and values while advocating for the patient’s right to self-determination and to make informed choices.
• Documents all chart and phone reviews, identifies, and communicates potentially avoidable / non-reimbursed days, and quality indicators (such as re-admissions).
• This position acquires and maintains knowledge and competencies related to the expectations of their positions including an extensive knowledge of post-acute admission criteria (Rehab, LTAC, SNF, Home Health, etc.

Practice is aligned with the mission, vision, and goals of the Integrated Health System.

Must be able to prioritize and assess situations while maintaining quality services under stressful conditions.

This position does not provide patient care.

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job.

It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications

Requirements - Required and / or Preferred

Name

Description

Education :

Must have working-level knowledge of the English language, including reading, writing, and speaking English. Appropriate education to obtain and maintain State of Nevada Registered Nurse licensure or State of Nevada Social Work licensure.

Experience :

One year experience in the acute hospital setting as either an RN or Social Worker, required. Individuals with leadership experience will be given preference.

License(s) :

Obtain and maintain a State of Nevada Registered Nurse license or State of Nevada Social Work licensure.

Certification(s) :

National Certification in Case Management (CCM) preferred.

Computer / Typing :

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Teams, Excel, and Word. Must have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.