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The University of Mississippi Medical Center (UMMC) RN Case Manager I ED Child Hospital R00009939 in Jackson, Mississippi

This position is for a RN-Case Manager I ED - Children's Hospital - FT - with a company located in Jackson, MS. Summary: Under the general direction of the manager of case management, the ED case manager is responsible for initiating the provision of an organized patient focused system that coordinates the delivery of quality healthcare services across a continuum of care beginning in the ED by continually monitoring, evaluating, and modifying the treatment plan to achieve optimal patient outcomes. This system emphasizes patient and customer satisfaction and balances individually identified patient and family needs with the efficacious use of resources. Duties and Responsibilities Include: Using criteria, conducts admission review/status screening for medical necessity and level of care needs for all potential admissions to the facility; inpatient or observation. Assesses the appropriateness of the level of care, diagnostic testing and clinical procedures, quality and clinical risk issues and documentation sufficient to substantiate medical necessity. Uses quality screens to identify potential issues and forwards information to clinical quality review department. Assess, develop, and implement the ED patient's discharge planning needs - involving patient, physician, family, and other members of the health care team to ensure a safe and timely discharge from the ED. Communicates patient needs to appropriate professionals, i.e., social worker, clinical pharmacist, diabetes educator, dietitian etc., and provides follows up communication. Discusses payor criteria and issues on case-by-case basis with clinical staff and follows up to resolve problems with payors as needed, communicates with patients and families to ensure understanding of 3rd party payer guidelines and patient responsibility. Manages all aspects of discharge planning for assigned patients. Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician. Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, and teaching and ongoing evaluation. Ensures / maintains plan consensus from patient/ family, physician and payor. Makes appropriate referrals for home health care, home medical equipment, acute rehab, or extended care facility placement (if possible, from the ED), coordinating transfers to other facilities/agencies. Seeks out information and resources and uses creative problem solving for discharge planning, quality of care and utilization issues. Explores new resources when the opportunities for the patient are absent or in short supply. Refers appropriate cases for social work intervention based on department criteria. Act as a patient advocate in by providing patients/families with special needs with appropriate resources and referral. Assist homeless patients with information on shelters, emergency food lockers, emergency clothing resources and other services available for the population. Collects delay and other data for specific performance and /or outcome indicators as determined by administrator - resource management. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., emergency department flows and care). Uses pathway data in collaboration with other disciplines to ensure effective patient management. Leads the development, implementation, evaluation and revision of clinical pathways and other case management tools as a member of the clinical resource team. Acts as preceptor/ mentor to new hires. Assists in development of orientation schedule and helps identify individual needs for learning. Ensures safe care to patients adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of pra