Integrated Case Manager

Utilizing the case management process, the Integrated Case Manager (ICM) coordinates transitional care for the children/families for an assigned medical team. Responsible for effective coordination of care, the ICM collaborates with providers to assure all patient stays meet the needs of the patient to discharge in a safe and efficient manner. In addition, based on the needs of the department also performs the functions of a Hospital Case Manager (HCM).

Responsibilities

Coordinates transitional care for the children/families for an assigned medical team utilizing the case management process; Collaborates with providers to assure all patient stays meet the needs of the patient to discharge in a safe and efficient manner; Performs the functions of a Hospital Case Manager based on the needs of the department; Conducts initial and ongoing assessment of the patient's clinical situation and physical and behavioral needs; Leads the implementation and management of a care coordination plan by collaborating with members of the care coordination team, family/care givers, treating providers, hospitals and other facilities, community agencies and services; Attends all patient rounds with assigned Provider teams; Documents all acute care admissions as avoidable potential denials when InterQual criteria are not met; Documents all length of stay concerns as avoidable potential denials; Collaborates with Providers on the attending team to discuss differences in LOC assignment; Ensures that patients receive appropriate services across the continuum of care and continuity of care across service levels and among providers; Provides or arranges outreach calls or visits to patients to insure appropriate delivery and access to aftercare services; Communicates self-pays and out-of-network payors to financial clearance department; Provides education to families about outpatient/observation level of care and potential co pays; Understands and satisfies the continued needs of the neonate, infant, toddler, pre-school, school-age, adolescent and/or young adult patient in regard to their growth and development as they transition home or to an alternate level of care; Demonstrates teamwork within the department by assisting other staff members as necessary

Requirements

Associate's Degree Nursing; License RN-Registered Nurse (30) - State of Wisconsin; Independent judgment, analytical ability, systems thinking and highest level of interpersonal communications to work effectively in complex systems; Able to collect pertinent clinical information while maintaining a good rapport and relationship with providers; Considerable skill in interpreting clinical treatment information resulting in successful linking of patients with providers and resources throughout the continuum of care; Computer knowledge and skills in WORD, Outlook, Excel and Internet use; Ability to learn and navigate hospital specific programs such as Origami, Epic and Electronic Health Records; An understanding of the impact of healthcare delivery systems on the patient and family

Nice to have

Bachelor's Degree Nursing; Minimum of 2-3 years of case management experience; Previous experience in pediatrics, discharge planning, home care, and/or other care of the child/family; ANCC certification or CCM-Certified Case Manager - Commission for Case Manager Certification; Expertise in Utilization Management and understanding of InterQual criteria; Knowledge of patient care, case management theory and practice