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Cleveland Clinic



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Health Care-Cleveland Clinic
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Hospital: Cleveland Clinic Florida
Job Code: 000278
Pay Grade: 16
Schedule: PRN
Shift: Rotating shifts
Hours: 8am-5pm, 3pm-11pm
Job Details:


The Case Manager works in collaboration with other members of the health care team and external agencies to facilitate efficient patient treatment along the continuum of care. Goals involve monitoring patient outcomes, optimizing resource utilization and implementing continuing care plans to meet patients' post-discharge needs.


A. Education, Knowledge, Skills and Abilities

Minimum: Degree in Nursing of health related field preferred

B. Required Length and Type of Experience

3-5 years clinical nursing and 2 years hospital case management experience. Working knowledge of InterQual Acute Care guidelines. Effective verbal, written and computer skills.

C. Required Licensure, Certification or Registry

Current Active Florida RN License


1. Reviews patients one business day after admission to determine medical necessity and appropriateness referencing InterQual Criteria severity of illness and intensity of service for admission in an acute care setting and reassesses cases at a minimum of every 48 hours for and continued stay referencing InterQual criteria intensity of service in an acute care setting; uses chart review, electronic medical record, patient/family interviews, and interdisciplinary team as information sources.

2. Organizes, plans and prioritizes caseload to optimize care coordination; provides intense case management for patients with high risk factors (e.g., age>75, living alone, frequent readmissions, physical / cognitive limitations).

3. Evaluates discharge planning needs on admission review; collaborates with pt/family, physicians, nurses, ancillary personnel and external agencies to develop safe, individualized, and appropriate continuing care plans.

4. Obtains consent from patients for continuing care providers; initiates timely referrals, discharges, and transportation arrangements; ensures appropriate information is provided to anyone responsible for continuing care support.

5. Identifies appropriate hospice candidates and communicates with physician regarding options.

6. Reviews observation patients each day to determine appropriate level of care and patient status; confers with Admitting and Business Office departments regarding authorization issues as needed.

7. Evaluates use and scheduling of hospital resources and intervenes to prevent over/under utilization; identifies opportunities to prevent avoidable days and reduce length of stay; uses effective problem solving techniques.

8. Participates in development of interdisciplinary care plans and documentation of patient education. Identifies educational needs of patients, families and staff and takes appropriate actions; assesses readiness for understanding and assuming responsibility for ongoing care as needed.

9. Identifies avoidable hospital days and not limited to other inappropriate utilization. Confers with director regarding findings.

10. Facilitates multidisciplinary communication to maintain ongoing, positive relationships with healthcare team, patients, families, payors/TPA and community providers; functions as a resource to all customers to optimize care coordination and resource utilization

11. Initiates and leads team conferences to achieve consensus regarding continuing care plans.

12. Establishes positive rapport with patients and families; supports decision-making and advocates for patient to ensure advantageous use of benefits; demonstrates awareness and sensitivity to patient rights.

13. Demonstrates knowledge of legal issues, COBRA regulations and regulatory agency requirements; issues notices of non-coverage, important message per CMS guidelines when necessary.

14. Initiates and completes level 1 PASRR screen for all patients going to snf level of care upon discharge

15. Makes appropriate referrals to Social Worker; demonstrates appropriate delegation of duties in the coordination of patient care issues.

16. Provides timely and thorough review to insurance companies/TPA.

17. Documents assessments, interventions, patient progress, education, referrals and insurance information in CM progress notes in a timely, accurate manner, as per policy.

18. Participates in meetings, policy development, reports and other activities that support the CM and hospital functions; willingly participates in special projects as requested.

19. Ability to complete successfully McKesson InterQual(R) Interrater Reliability Exam.

20. The RN would be responsible for the LPN for the gathering information necessary for completion of the nursing process.

21. Other duties as assigned.

Category: Managerial/Professional/Physician

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