The Care Management department provides several major services to assure a safe and efficient passage of patients through their acute hospitalization and transition to the next level of care. Our goal is to balance individual clinical and psychosocial patient/family needs with the efficient and cost effective utilization of resources while promoting quality outcomes.
RN Case Managers provide a coordinated approach with in the interdisciplinary team in determining appropriateness of admission, continued stay in the hospital and planning for transition to various levels of care in the hospital, community and home. Intensity of service is dependent on individual patient needs as assessed by the case manager. Nurse Case Managers assure robust utilization review, resource management and discharge planning.
RN Care Managers assess patients on admission for available family support, insurance resources, and potential discharge planning needs. They use established criteria to determine appropriateness of admission and continuing stay and work with insurance companies to assure ongoing authorization for continued stay and post hospital needs. Daily care coordination rounds occur on each nursing unit Monday through Friday at which Case Managers meet various disciplines to discuss the plan for the day and the plan for the patients stay. They will also frequently lead and/or be involved in multidisciplinary care conferences with family involving complicated care situations. They contribute to meeting OHSU’s strategic plan of safe LOS reduction and reduction in readmission rates.
Admit/ED Nurse Case Manager: In addition to the above basic CM functions, also provides the following –
Evening Shift Case Manager
RN Case Managers are responsible to be aware of and comply with regulatory requirements of DNV, Medicaid, Medicare and Oregon Nurse Practice Act.
Department Specific Working Conditions:
Case Management is represented on every unit and the Emergency department.
The Care Management central resource office is located in 9A4.
Each Case Manager has an office with a work station near the unit they are assigned to.
Communication factors: Case Managers are available by pagers 7 days a week during the day. They are also available by telephone/voicemail and e-mail.
Department Specific Requirements (competencies, equipment, certifications, etc.):
Proficiency within the interdisciplinary team in leading daily discharge rounds, negotiating conflicts, coordinating patient goals between disciplines, communicating about and educating physicians on patient status decisions.
Ability to describe what utilization review criteria is and how it is utilized.
Proficiency with managing difficult and sensitive family and provider care conferences including: adjustment to new levels of function, end of life discussions, imbalance of available resources (social, spiritual, medical, financial).
Progressive leadership positions with in nursing unit – examples include: Charge nurse, UBNPC Chair/Member, Shared Governance councils.
Usual Orientation Time:
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