Job Posting Description

The Case Management RN (CMRN) is responsible for assessing and developing the discharge plan for patients on the medical units. The CMRN facilitates the discharge plan to prepare for a safe transition to post discharge care by working with the parent/guardian, interdisciplinary team and community based providers; and works with the patient where developmentally appropriate related to discharge planning. The CMRN updates third party payers with clinical information regarding medical necessity for continued hospitalization and communicates concerns regarding medical necessity for hospitalization and denials to the health care team. The CMRN submits clinical information for utilization review.

• Supports the philosophy, mission, values, policies and procedures of Franciscan Hospital for Children. Serves as a resource to members of the health care team, patients, and families regarding community services for patients requiring post-discharge care
• Starts plan for post discharge transition beginning at admission
• Involves the patient in the discharge planning process where developmentally appropriate
• Works to establish an effective relationship with parent/guardian to foster a safe discharge plan with the highest level of wellness possible
• Elicits information from parent/guardian regarding: their expectations of hospitalization and length of stay, home services and medical providers prior to hospitalization, their choices of home providers, and home caregivers who will learn all of the child's care as needed
• Explains and discusses with parent/guardian the discharge planning process including the process to learn care and to coordinate home based services; refer parent/guardian to other team members when appropriate
• Attends team rounds and family team meetings, contributing pertinent discharge planning information
• Participates in and initiates patient care conferences as needed to foster optimal patient care and discharge planning
• Develops an individualized family-centered discharge plan of care
• Organizes and leads discharge planning meetings with parent/guardian and interdisciplinary team to facilitate parent/caregiver understanding and partnership in the discharge plan; this meeting may also include post discharge providers when beneficial to attend
• Assists in the determination of third party coverage for home based services and equipment when appropriate
• Coordinates post discharge services with attention to timing of commencement of services to coordinate with discharge date and patient needs
• Lists the medical follow up appointments and home providers with their contact information for parent/guardian; discuss this list with parent/guardian prior to discharge to assure agreement and understanding of discharge plan
• Maintains accurate case management records, including all significant parent/guardian encounters, and document appropriately in the medical record, to include ongoing updated details of discharge plan
• Compiles discharge documents to be faxed to follow up providers for continuity of care
• If transferred to acute hospital and discharge home from acute hospital is the plan, communicates with CMRN at acute hospital to coordinate discharge plan
• Makes post hospitalization phone call to parent/guardian to address unexpected concerns, assure the necessary home services have commenced and to reinforce how to contact/navigate community based providers. This phone call is made within 24 hours of discharge for medically complex patient

EDUCATION

• BSN or MSN
• Three years of nursing experience, with at least two years in pediatric nursing which may include payer responsibilities related to Case Management, utilization review and discharge planning of a pediatric population; knowledge of the concepts and philosophy of case management, utilization review regulations, and relevant medical standards of practice.