Nursing Case Coordinator-STMC-Case Management

Job Description

The role of the new entrant Case Coordinator is to coordinate the multidisciplinary team, and any other appropriate and accredited healthcare provider in the provision of quality patient care, under the guidance and supervision of the Senior Case Coordinator

Responsibilities

Managerial The role includes advocacy & education, facilitation, transition & financial management, outcomes & psychosocial management in order to promote quality, safe and timely transition through the healthcare system.

Under supervision and guidance from the Senior Case Coordinator, the case coordinator will coordinate appropriate providers and access appropriate services to progress the patient’s episode of care in a timely manner.

Until competency level has been achieved as per competency evaluation, the Case Manager will develop patient care plans to include:

• Correct Level of care placement- Utilization Management
• Care Facilitation along the Continuum of Care, monitoring against Clinical Pathway, and facilitation of transition plans
• Proactive Discharge Planning
• Facilitation of accurate medical documentation and health insurance documentation
• Facilitation of Resource Utilization- ensuring the available funding meets the clinical needs
• Links the physician staff with finance.
  
  
  

Technical

• Actively participate in regular communication and feedback with Senior Case Coordinator.
• Under guidance, apply appropriate Evidence Based Medical Necessary screening criteria in support of admission and continued stay reviews and communicates with payers as necessary.
• Under supervision, coordinate/ delegate to multidisciplinary team members, to ensure patient care progression throughout the continuum, to ensure that necessary services are provided at the most appropriate level of care and there is a smooth progression of the patient throughout the healthcare system by:
• Working collaboratively and maintaining active communication with physicians, nursing and other appropriate members of the multidisciplinary team to effect timely, appropriate patient management.
• Proactively identifies and resolves variances to clinical pathway and obstacles to discharge.
• Seek consultation from appropriate disciplines / departments as required to expedite care and facilitate discharge.
• Learns and comprehends, working knowledge of patient’s benefits under Insurance contract to ensure patient care is rendered to the maximum stipulation but does not exceed the providers’ provision for cost of care and collaborations with team to obtain documentation to support medical necessity.
• Monitors the patient’s progress, consulting with Senior Case Coordinators on appropriate intervention as necessary to ensure that the plan of care and services provided are patient focused, quality, efficient and cost effective.
• Seeks consultation with the Senior Case Coordinator to facilitate and coordinate the following in a timely manner:
• advocacy & education of the patient, family and relevant others by appropriate care team members
• transition management to ensure the patient is transitioned to the appropriate level of care
• monitoring and intervening as necessary to achieve desired goals and outcomes for both the patient and the hospital
• early assessment and intervention (once deemed competent) to address psychosocial needs including patient, family and community and collaborates with Social Workers as appropriate
• communicate closely with Utilization & financial managers regarding insurance and other financial issues to ensure appropriate reimbursement for services (once deemed competent)
• Completion of all required documentation in patient medical file.
• Obtains and maintains appropriate releases of information
• Completes Case Management and quality screening for assigned patients (once deemed competent)
• Under supervision of Senior Case Coordinator, applies approved utilization acuity criteria to monitor appropriateness of admissions and continued stay and documents findings based on department standards.
• Monitors length of stay and resource use on an ongoing basis and discusses trends with Senior Case Manager.
• Uses quality screens to identify potential issues, discuss with Senior Case Manager appropriate planning and interventions.
  
  
  

Quality & Safety

• Participates in clinical performance improvement activities
• Assists in the collection and reporting of indicators including LOS, excess days, resource utilization, and readmission rates.
• Gather, interpret, and use data to identify problems and trends and to demonstrate outcomes and cost-effectiveness
• Participates in Quality Assurance programs within the clinical care setting
• Assists in development of CQI processes for Case Management
• Actively participates in the development and implementation of Case Management projects including Clinical Pathways, Quality Improvement tools, data analysis and variance reporting
• Supports physicians in relation to Clinical Documentation impacting Medical Necessity, Case Mix Index, and Severity of Illness
  
  
  

Education

• Planning, teaching, supervising and counseling (as required) regarding physical care measures to promote improvement/recover, symptom/complication management, expected disease progression, social/emotional care and community resources
• Keeping abreast of Professional Case Management Practice development and updating requirements.
• Facilitating patient education based on identified learning needs of the patient and/or those providing care and documents appropriately
  
  
  

Qualifications

Qualification :-

Special Certificate:-

Required Experience

• Charge Nurse experience as per DOH PQR /+ 2 years experience Case Management
  
  
  

OR

• Staff Nurse experience as per DOH PQR / + 4 years experience Case Management
  
  
  

OR

• Being current SEHA Senior Charge Nurse or Charge Nurse or Staff Nurse with no experience in Case Management but Completed SEHA Case Management Training Program in lieu of Experience required (this condcition is applicable only for current SEHA employees not new joiners)
  
  
  

Desired

Experience in Large Healthcare facility

About Us

Abu Dhabi Healthcare Company (SEHA) is the largest and most comprehensive healthcare network in the UAE that was established in 2007 with the objective of operating all public hospitals and clinics across the Emirate of Abu Dhabi.

SEHA is committed to delivering world-class healthcare services using the most advanced diagnostics and systems across its network of public healthcare centers and hospitals in addition to partnering with global leaders in healthcare, including world renowned organizations such as the Mayo Clinic.

About The Team

Tawam Hospital is a premier 461 bed tertiary care facility located in Al Ain and is one of the largest hospitals in the UAE.Tawam offers services in specialties including oncology, neonatal care, emergency medicine, intensive care, surgery, urology, family medicine, fertility services, neurosurgery,