Case Reviewer – Clinical Resource Utilization Management – Temporary Full Time

PURPOSE:

To review and coordinate care from preadmission to discharge through daily evaluation and planning with the interdisciplinary team. The case reviewer evaluates the patient’s treatment plan and goals to ensure that the right care is in place at the right time across the patient’s continuum. The case reviewer works to identify delays in treatment and barriers to safe, timely discharge while working   The Case Reviewer works collaboratively with the inter-professional team to coordinate and improve access to treatments and diagnostics improving communication and coordination of discharge goals.

DUTIES:

1. Participate and collaborate with other health care providers in the provision of patient care.
2. Effectively use the Standards of Nursing Practice and the nursing process to assess, plan, implement, and evaluate patient care.
3. Provide health teaching to patients and family.
4. Compliant with legislation, and organizational and departmental policies, standards, and procedures.
5. Maintain commitment to self-growth and professional development by remaining current in knowledge and application of best practice through the utilization of appropriate research and literature.
6. Demonstrate excellent interpersonal and conflict resolution skills.
7. Participate in ongoing quality improvement and risk management activities.
8. Maintain current knowledge of best practices and benchmarks for the delivery of services, appropriate research, literature, accreditation requirements, and implementing improvements/changes as appropriate.
9. Participate in daily bullet rounds identifying readiness for discharge barriers.
10. Participate in interdisciplinary rounds and Alternative level of care processes.
11. Engage with community partners to support and create supportive and safe plans
12. Work with interdisciplinary team to create estimated discharge dates based on evidence based best practices.
13. Coordinate and lead patient/family care conferences in collaboration with the inter-professional team.
14. Monitor conservable day triggers, communicating and coordinating action plans with the appropriate service providers (Physicians, Nursing, Allied Heath, Diagnostic, Lab, Community Agencies etc.) to eliminate wait times.
15. Engage as an active member of the interdisciplinary team on their assigned unit.
16. Ensure documentation meetings College of Nursing practice standards. Ensure daily monitoring and timely recording of patient service level changes.
17. Maintain ALC tracking reconciliation to assist with prioritization of transfers an ALC escalation process.
18. Communicate discharge information to patients and family
19. Communicate and record expected discharge date in collaboration with the inter-professional team.
20. Completion of Health Assessments.
21. Other duties as assigned.

QUALIFICATIONS:

1. Current registration with the College of Nurse of Ontario in good standing.

EXPERIENCE:

1. 5 years of experience in a hospital setting.
2. Experience in case management, care coordination, patient system navigation or working with external community partners.

SKILL/ABILITY:

1. Competency in nursing care appropriate to specific clinical area including Medical, surgical and Emergency.
2. Knowledge of patient care requirements and specialized equipment as appropriate to the clinical area.
3. Demonstrated ability to facilitate difficult conversations.
4. Excellent ability to work effectively and efficiently as a team member in a fast paced environment in stressful situations.
5. Computer literacy in a Microsoft environment.
6. Ability to maintain successful working relationships with the interdisciplinary team to achieve positive patient outcomes.
7. Ability to organize time effectively to perform the duties of the position.
8. Ability to meet and interact with people in a pleasant, professional, responsible and reassuring manner.
9. Ability to read, write and communicate to perform the duties of the position.
10. Human relations skills including empathy, sensitivity, understanding of human and organizational behavior, motivational techniques and counseling skills (e.g. teaching patients).
11. Critical thinking and problem solving skills.
12. Advanced knowledge of available services in-hospital and in the community and how to access these services.
13. Advanced knowledge of Ministry of Health policy decisions that affect utilization management strategies and funding.
14. Behaviour consistent with Hospital Mission, Values and Standards of Performance.

Note: Because of the changing nature of the work and work to be done, other responsibilities and duties may by assigned and qualifications may be adjusted from time to time.