As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.
This position is responsible for the coordination of care of individual patients. The group for this current position is comprised of infants and children who are technology-dependent. Through the nursing process, the patient care will be assessed, planned, implemented and evaluated with consideration to the appropriate use of resources. The Case Manager will coordinate care with a focus on designated clinical, operational and financial outcomes for aggregate patient populations. In collaboration with the interdisciplinary team and a family-centered process, the Case Management nurse will work to improve outcomes as measured by efficiently coordinated care, timely discharge, reduced readmission rates and improved patient/family satisfaction.
1.Determine medical necessity, appropriateness of admission, continuing stay and level of care using a combination of clinical information, clinical criteria and third party information. Intervenes when determinations are not in alignment with clinical information, clinical criteria or third party information to resolve the situation. Documents all Case Management interventions in the Electronic Medical Record (EPIC).
2.Validates admission and continuing stay criteria with third party payers as well as the Attending Physicians. Recommends alternative care sites where appropriate. 6 March 2007
3. Collaborates with third party payers to prevent denial of payment and proactively addresses issues contributing to a potential denial. Intervenes to prevent the denial when possible.
4.Supports the effective prevention and management of denials, including providing requested information as part of the appeal process.
5. Assesses the patient and family for continuing care needs to develop, implement and evaluate an effective discharge plan in collaboration with the multidisciplinary team. Uses knowledge of usual length of stay to initiate a plan for discharge.
6.Uses clinical knowledge and knowledge of anticipated response to treatment to assess patient progression towards anticipated outcomes. Communicates and coordinates with the patient/family and health care team to intervene when progression is stalled or diverted. Addresses actual/potential barriers to discharge.
7.Completes the interventions necessary for discharges to home with self care, home with services or short term skilled nursing facility placement. Assembles necessary referrals, discharge summaries and pertinent information for discharge to home, placement, or transfer prior to the day of discharge.
8.Actively contributes to, participates in, and follows through on interventions identified in care coordination and complex patient rounds.
9..Identifies high risk patients and creates a collaborative plan to address their unique needs.Conducts initial clinical reviews within 24 hours of patient admission. All reviews are to follow unit standards as per CM concurrent review guidelines.
10.Monitors and facilitates correct patient class and accommodation codes via the EMR for every patient.
1.Screens and reviews inpatient medical records using evidence-based guideleins to determine severity of ilness on admission. Screens patients and families for risk factors requiring case management assessment and interventions, identifying potential for complex discharge planning needs.
2.Promotes collaboration and coordination of health care services and discharge planning for patients and families as they progress along the care continuum.
3.Promotes patient/family choice when options for care are decided; educating patients and families about available health care resources and advocating for their empowerment in quality of life decisions in the healthcare setting and the community where the pateint and family reside.
4.Engages in organized, on-going communication between team members, including the patient and family for the exchange of accurate healthcare information.
5.Maintains current, in-depth knowledge of care management standards of professional practice..
6.Maintains strict confidentiality with regard to patient and personnel information.
7.Maintains current discharge information in the Electronic Medical Record.
8. .Understands and effectively manages cost consideration, maintaining a comprehensive knowledge of resources, payer requirements, and service network guidelines and the regulatory standards specific to care management.
9. Identifies and communicates innovative opportunities to improve patient and family care and the Case Management process.
RN license required
5 years of nursing experience required
Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.
Nemours is committed to improving the health of children. As a non-profit children’s health organization, we consider the health of every child to be a sacred trust. Through family-centered care in our children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania and Florida, as well as world-changing research, education and advocacy, Nemours fulfills the promise of a healthier tomorrow for all children — even those who may never enter our doors. Nemours began more than 70 years ago with the vision of Alfred I. duPont to improve the lives of children and to do whatever it takes to prevent and treat even the most disabling childhood conditions. Today, through our children’s hospitals and health system, we directly care for 250,000 children annually in Delaware Valley and Florida, including families who travel from across the country and world to see our specialists — treating every child as we would our own. We also reach beyond the walls of our hospitals and clinics to be a voice for children on a national and international level, and to lead the way in prevention, intervention, education, and research. Nemours is growing to better serve the children and families in our ca...re. We have 1.1 million square feet of space currently devoted to providing children’s healthcare or under construction, all designed with significant input and advice from our patients and families.