Banyan Medical Systems
  • FL, USA
  • Hourly
  • Full Time

We provide excellent benefits, including health insurance, paid time off (PTO), 9 paid holidays, a 401(k) with company match, tuition reimbursement, fun company events and company swag


Banyan Medical Systems is looking for professionals in the healthcare field who can learn the Banyan products and provide virtual care services to the Managed Services Clients. As a member of the Managed Services team, the Virtual Case Manager will coordinate the plan of care and provide comprehensive care coordination and oversight of patient's care remotely on the Managed Services Clients' inpatient unit(s). The RN Virtual Case Manager, in collaboration with members of the inter-disciplinary healthcare team, leads the development and implementation of the multidisciplinary plan of care for patients, determining appropriate patient status and level of care; ensuring effective quality and cost-efficient outcomes by performing concurrent and retrospective case review, and supervising the provision of the discharge plan of care. This position functions as the key linkage between the physician, staff, and hospital leadership in the day-to-day management of appropriate and efficient patient care and functions as an advisor to the physician with accountability to escalate cases to the Medical Director (as necessary) to ensure the provision of appropriate and effective patient care.

The Virtual Case Manager will collaborate with the multidisciplinary team, including Physicians, Registered Nurses, technicians, and other healthcare providers, for care coordination, education and virtual assessments on admission and discharge. The Virtual Case Manager will also be responsible for monitoring quality metrics specific to the department and ensuring complete and accurate documentation in the patient record of the data collected for those metrics. A high degree of professional competence and autonomy will be demonstrated in performing the roles of 1) clinician, 2) educator, 3) consultant/collaborator, and 4) navigator.

The Virtual Case Manager is responsible for the assessment, planning, implementation, coordination, monitoring and evaluation of the patient's plan of care from admission to post-discharge. The Virtual Case Manager utilizes clinical knowledge, critical thinking skills, and the principles of case management to coordinate and implement a discharge plan that meets the patient's needs and ensures a seamless, effective, and efficient transition of care across the continuum.

PREREQUISITE SKILLS: Case Manager

Must have the ability to read, write, and follow English verbal and written instructions, and have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, and positive personal influence and negotiation skills.

Leadership skills to delegate, functionally supervise, provide direction/guidance to staff and hold others accountable are required.

Must have the ability to work independently with a minimum of direction, anticipate and organize work flow, prioritize and follow through on responsibilities.

Must have strong clinical assessment and critical thinking skills necessary to provide utilization review/discharge planning services appropriate to patients with complex medical, emotional and social needs.

Strong attention to detail and accuracy is required.

Must have the ability to work in a high-volume case load environment and deal effectively with rapidly changing priorities.

Demonstrated ability to work constructively with a broad spectrum of health care professionals is required.

Must be assertive and creative in problem solving, system planning and management.

Proficient computer skills are required including use of Electronic Health Record and other IT applications.

Must be effective as both a team member and a leader.

KNOWLEDGE

General knowledge of supervisory principles/applications is required.

Must have a working knowledge of disease processes, current treatments and their physical and psychosocial sequelae.

Knowledge of individual and family development over the life span is required.

Knowledge of the influence of cultural and spiritual values on health care is required.

Basic knowledge of applicable laws, regulations, and accreditation guidelines (e.g. CMS, DHS, Joint Commission, EMTALA) is required.

Basic knowledge of government and private insurance benefits (e.g. Medi-Cal, Medicare, DRGs, managed care, capitation), including reimbursement requirements is needed.

Must know child, elder and dependent adult and domestic violence reporting requirements.

Working knowledge of Inter-Qual criteria.

ESSENTIAL FUNCTIONS Care Facilitation and Coordination:

Coordinates care for an assigned unit-based patient population in a paired team model comprised of RN Case Manager and MSW Social Worker.

Works with the multi-disciplinary healthcare team to ensure the plan of care is expedited and barriers to efficient throughput are identified and corrected.

Creates a plan of care that outlines the key interventions and outcomes to be achieved each day of the inpatient stay. "Plan for the day - plan for the stay"

Can actively lead multidisciplinary case conferences in developing comprehensive, cost-effective case management plans that span the continuum.

Makes independent assessments and recommendations regarding course of action in complex situations and recommendations relevant to multi-system or special needs Patients.

Identifies and refers quality and risk management concerns to appropriate level for corrective action plans and trending.

Proactively solicits physician's orders for services.

Demonstrates knowledge and skills necessary to provide cultural, spiritual and age specific care by obtaining specific care information and assessing relevant information needed to identify each patient's unique treatment and discharge planning needs.

Utilization Management Specific Interventions

RN Case Manager completes an admission review using standardized criteria (Inter-Qual) within 24 hours of admission and documents review outcome.

Escalates to the Physician Advisor when criteria are not met and attending physician disagrees with findings.

Completes a continued-stay review according to policy to assure patient is at the appropriate level of care.

Monitors the length of stay in comparison with MS-DRG/GMLOS for all patients.

Completes concurrent review for specified health plans and includes medical necessity documentation to avoid payor denials.

Ensures that the patient is transitioned to the next level of care as quickly as possible once the patient no longer meets clinical criteria for the current level of care.

Works with physicians and CDI to ensure that clinical information available in the medical record is accurate and reflects the care rendered to the patient.

Collaborates with physicians to determine appropriate levels of care for post hospital care, use of hospital resources, and available community resources.

In a timely manner, communicates pertinent information to third-party payers and managed care organization to obtain authorization for care and prevent denials.

Reviews, processes, and issues denials to client/responsible party following regulatory guidelines and facility protocols. Informs client/responsible party of right of appeal and the appeal process. Collects data for the appeals process.

Identifies avoidable days, intervenes to correct delays, and enters outcomes in MIDAS in a timely manner according to policy and procedure.

Uses personal judgment within broad guidelines to initiate review of inappropriate utilization by physicians and follows-through to resolution (e.g., attending, department chair, utilization management medical director).

Assessment/Care Coordination/Discharge Planning

Completes an initial discharge planning assessment within 24 hours of admission and documents findings in the CM-Assess tab in the electronic health record.

Reviews initial hospital admission and gathers additional medical, psychosocial and financial data from needs assessment, client/family, physicians, and other health care providers. Determines risk level and identifies client's service needs.

Performs AUDIT (Alcohol Use Disorder Identification Tool) for patients assessed on admission to be at risk based on standardized criteria.

Formulates a discharge plan after completing a face-to-face interview and discusses available/appropriate care options and obtaining input from the patient/family and physician, healthcare team, insurance companies, and community-based support services.

Collaborates with physicians to facilitate timely resolution of situations such as client concerns, need for referrals and discharge barriers to expedite the discharge plan.

Acts as a resource and content expert for the physicians regarding an optimal care plan for patients.

Identities potential problems, prevents and/or resolves variances to the case management plan. Effectively deals with resistance and conflict in working with member of the patient care team, physicians, clients, and families.

Implements all aspects of the discharge plan of care, intervening in an appropriate and timely basis when difficulties arise. This may require documentation and follow-up with other management staff to ensure effective resolution.

Mobilizes resources to effect rapid and timely movement of the patient through the system to achieve targeted discharge times established by MGH policy.

Identifies and mobilizes patient's and family's strengths to optimize use of healthcare and community resources. In coordination with patient/family wishes, guides/assists in securing needed post discharge services, which may require negotiating for services covered but not readily available.

Implements the discharge plan to include all the necessary referrals and authorizations as identified by federal, state, and local insurance regulatory agencies and offers patient choice per regulatory guidelines.

Department Operations and Professional Development

Actively participates in department meetings and operations, including process development or improvement (e.g., department orientation, internal mentor/training programs and initiates, disease and population management strategies, appropriate measures for evaluation of outcomes) and establishment of department goals, objectives, and budget.

Ensures all applicable department and regulatory targets for productivity and department performance process improvement are attained (e.g., hospital length of stay, average cost per discharge, and re-admission rates, etc.).

Complies with all reporting requirements for mandated, risk management, and other medical/legal situations consistent with confidentiality policies and department standards.

Actively contributes to the development and maintenance of a care delivery system which is sensitive to individual patient needs, promotes effective resource utilization, and supports physician practice, while emphasizing coordination across the continuum.

Positively contributes to team's decision-making process, effectively collaborates with other team members on interdependent tasks, and actively supports implementation of plans to accomplish team objectives.

Prepares and conducts presentations to multidisciplinary teams related to special projects, case management, etc.

Adheres to department and facility policies and procedures and supports philosophies and initiatives.

Maintains accurate, current, and legible patient records using approved forms and format, according to department and entity standards, including patient assessments, plans, interventions, patient/family involvement, outside agency communications, and interdisciplinary contacts.

SECONDARY FUNCTIONS (modifiable); RN Case Managers

Actively participates in ongoing department interviews for RN/SW Case Managers and Department Assistants, effectively recommending selected applicants for hire.

Recommends or provides necessary training to staff.

Attends and participates in community-based committees and task forces, when applicable and staff is available.

Other duties as assigned.

QUALIFICATIONS

  • Education: Must be a graduate of an accredited college of with a Bachelor of Science degree in Nursing preferred

Experience:

  • One (1) + year Acute Inpatient RN Case Manager experience performing both UR and discharge planning for a patient caseload. Substantial recent experience in utilization review and/or discharge planning in an acute care setting is strongly preferred.
  • Three (3) or more years of RN experience in an acute patient care setting, preferably in medical/surgical or critical care.
  • Broad nursing clinical background strongly preferred.
  • Experience working efficiently with multiple computer applications in a fast-paced work setting
  • Experience demonstrating leadership skills and inter-disciplinary collaboration preferred.
  • License/Certifications: National certification (ACM) in Case Management preferred.
  • Special qualifications: Manage and communicate data and information in clinical informatics work environment to Managed Services Clients, nurses, health care providers and patients. Act as the liaison between health care providers and technology staff. Must be able to successfully complete established competencies for the position within designated probationary period. Effective communication skills; both orally and written. Computer skills needed. Ability to manage and work with others within a team to ensure quality patient care. Strong critical problem- solving skills. Ability to respond to common inquiries or complaints from customers or regulatory agencies. Ability to lead, plan and delegate tasks appropriately. Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to work independently and under pressure. Knowledge of government and third party reimbursement systems and contracts.
  • Hours of work: Part-Time and/or Full-Time Non-Exempt
  • Experience and knowledge of the following Microsoft System: Active Directory, Exchange, Skype for Business, and Office 365
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