Within the inpatient setting to assess and address patient and family needs related to effective and efficient movement through the hospital system and beyond.
1.\tPerform initial screening on all patients within one day of patient being available to the case manager. Begin discharge planning process on patients deemed to be high risk through the screening process.
2.\tEnsure that the patient transitions through their stay without barriers or delays in care delivery and discharges to appropriate level of care.
3.\tWork closely with interdisciplinary team to proactively identify discharge needs.
4.\tCoordinate discharges to the next level of care, working to facilitate safe transitions with the goal of preventing avoidable readmissions.

Expert Caring

Per department documentation standards:Completes initial screening, and comprehensive assessment as indicatedIdentifies discharge goals with patient/family early in hospital stayProvides and documents patient choiceInitiates and follows up on referrals to outside agencies for appropriate transition of careIdentifies and documents delays (when patient is ready, but not discharging)Completes documentation on all patients being followed by Case Management at dischargeAppropriately identifies need for UAI and Level II assessments and communicates need in a timely mannerActively participates in patient identification and problem-solving for clinical high risk or complex patients, and escalates cases to leadershipCoordinates with payors, as needed, to arrange care at transitionProactively identifies patient needsIdentifies resources, both internal and external to support patient transitionActs as a resource for patient/family, interdisciplinary team and Case Management colleaguesDemonstrates ability to adapt to changing patient needs

Empowered Leaders

Shares knowledge within team and with colleaguesActively participates in department operationsAttend meetingsReview minutes and provide feedbackHelp with pre-work or follow-up work

Lifelong Learning

Participates in continuing education offeringsStaff meetingsConferencesMaintains knowledge in specialty clinical areaSeeks experiences and/or mentorship to develop skills and advance knowledge, abilities in practice or role performance

Quality Achievement

Adheres to departmental documentation guidelines Incorporates evidence-based standard work into practice Understands organizational priorities, department outcome metricsArticulates and supports department and organizational improvement initiatives and coaches others in understanding of dataDemonstrates and/or verbalizes a sense of responsibility for patient outcomesActively engages in readmission prevention effortsSupports timely discharges

Innovation

Demonstrates competent use of multiple electronic platforms and serves as a resource for othersDemonstrates openness to change by actively seeking knowledge and information needed to adopt changeOffers suggestions for improved outcomes

Relationship Based Care: Self

Practices stress management by identifying own risk factors and utilizing coping mechanismsIdentifies strategies to prioritize daily work activities

Relationship Based Care: Colleagues

Educates interdisciplinary team on case management roleDemonstrates respectful verbal and non-verbal communication with all member of the team and addresses colleague behavior which does not support a respectful environmentParticipates in inter-professional collaboration and communicates the plan of care to team membersSeeks and offers help to teammates

Relationship Based Care: Patient/Family

Provides culturally sensitive care using resources to meet needs of the patientIncludes patient and family in planning of careMaintains professional boundariesExhibits non-judgmental and empathetic behaviorKeeps patient/family informed of progression/transition of careProvides education regarding transition needs and option base on learning needsMaintains open communication with patient, family and interdisciplinary teamAdvocates for patient and family

Position Compensation Range: $81,328.00 - $108,035.20 Annual

MINIMUM REQUIREMENTS

Education: Graduate of accredited nursing program. Bachelor's of Science in Nursing degree required within 5 years of hire or transfer into Case Management role.
Experience: 2 years of relevant experience required
Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required.

PHYSICAL DEMANDS
Job requires standing for prolonged periods, frequently walking, bending/stooping.  Proficient communicative, auditory and visual skills; Attention to detail and ability to write legibly; Ability to lift/push/pull 20-50 lbs.  May be exposed to chemicals, blood/body fluids, and infectious disease.

The University of Virginia is an equal opportunity employer. All interested persons are encouraged to apply, including veterans and individuals with disabilities. Click here to read more about UVA’s commitment to non-discrimination and equal opportunity employment.