Thanks for your interest in Children's Mercy!

Do you envision finding a meaningful role with an inclusive and compassionate team? At Children’s Mercy, we believe in making a difference in the lives of all children and shining a light of hope to the patients and families we serve. Our employees make the difference, which is why we have been recognized by U.S. News & World Report as a top pediatric hospital, for eleven consecutive years.

Children’s Mercy is in the heart of Kansas City – a metro abounding in cultural experiences, vibrant communities and thriving businesses. This is where our patients and families live, work and play. This is a community that has embraced our hospital and we strive to say thanks by giving back. As a leader in children’s health, we engage in meaningful programs and partnerships throughout the region so that we can improve the lives of children beyond the walls of our hospital.

Overview

The Nursing Care Manager is responsible for care coordination and to facilitate the patient throughput from admission to discharge including ancillary services, physicians, pharmacy, and care management. This role requires that the Nurse Care Manager uses advanced nursing process skills to promote safe, optimal, cost-efficient and satisfying patient/family outcomes. The Nurse Care Manager job functions include coordination of services for identified high-risk patients and families who receive care and services within the Children's Mercy Kansas City (CM) system. This position will also collaborate with physicians to do the following: monitor and report utilization of inpatient services and outpatient observation services including appropriateness of admission and continuation of current level of care to ensure reimbursement. Ensure appropriate bed status and establish clinical guidelines, function as a resource person and contact for insurance and other payer sources. Nursing Care Managers participate in ongoing professional development activities and make a meaningful contribution to quality improvement and continuing education of self and others.

At Children’s Mercy, we are committed to ensuring that everyone feels welcomed within our walls. A successful candidate for this position will join us as we strive to create a workplace that reflects the community we serve, as well as our core values of kindness, curiosity, inclusion, team and integrity.

Additionally, it’s important to us that we remain transparent with all potential job candidates. Because we value the safety of the patients and families we serve, as well as the Children’s Mercy staff, we want to let you know that theseasonal influenzaandCOVID-19vaccines are a condition of employment for all employees in our organization. New employees must be willing to be vaccinated if found non-immune to measles, mumps, rubella (MMR) and chicken pox (varicella) and/or without evidence of tetanus, diphtheria, acellular pertussis (Tdap) vaccination since 2005. If you become a finalist for this position, and have any concerns about receiving these vaccines, medical and/or religious exemptions can be further discussed with Human Resources.

Responsibilities

Critically evaluate operational and clinical factors affecting progression of care by using advanced nursing process skills to promote safe, optimal, cost effecient, and satisfying patient and family outcomes:

• P rovide early identification of high risk patients and needs by screening patients and families for risk factors (clinical, psychosocial, financial, operational) requiring care management assessment and intervention identifying the potential for complex discharge planning needs. Facilitates correct status order and level of care from start to alight with treatment plan.

• Demonstrates knowledge and proficiency with evidence-based clinical guidelines (MCG, InterQual)

• Critically evaluate operational and clinical factors affecting progression of care by using advanced nursing skills to promote safe, optimal, cost-effective, and satisfying patient and family outcomes.

• Complete admission reviews for all patients using critical nursing judgement and established evidence-based clinical guidelines.

• Communi cates correct status order, treatment plan, expected LOS, discharge plan to Third-Party Payer to promote payment for the organization for bundled services; recieving approval for all days to patient's stay and obtaining valid autorization for hospital stay.

• Identify root cause for readmission to include patient/caregiver perspective and implement strategies fo reduce future risk.

• Maintain timely documentation in EMR.

  Collaborate with physicians to monitor and report utilization of services, evaluating appropriateness of bed status, and ensures level of care services aligns with evidence-based clinical guidelines:

• To accomplish the goals of utilization management, the bed status must be correct from the time of admission, leading proper resource utilization, care, and management of the patient.

• Complete continued stay reviews for all patients using critical nursing judgment and established evidence-based clinical guidelines. Differentiates between normal and abnormal clinical findings.

• Monitors correct status order and level of care to align with treatment plan.

• Participates in multidisciplinary team rounds and collaborates in the development of the patient-centered plan of care, advocating for a treatment plan that aligns with evidence-based clinical guidelines.

• Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes and ensure continued stay documentation meets clinical condition.

• Monitors the progress towards the plan of care goals revising when necessary, completing a minimum of weekly reassessments.

• Evaluates the effectiveness of the of the discharge plan to ensure safety. Reduces or eliminates care fragmentation, duplication, and gaps in the plan of care.Intervenes to prevent adverse patient outcomes, when possible.

• Identify and address avoidable delays and implement strategies to avoid and manage unnecessary costs.

• Understands and effectively manages cost considerations. Maintains a comprehensive knowledge of resources, payer requirements, service network guidelines and the regulatory standards specific to care management. Utilizes financial and insurance resources of the patients to maximize the health care benefit to the patient.

• Efficiency and decreased health care costs are demonstrated by decreased lengths of stay, decreased readmissions, decreased denials, and increased patient satisfaction.

• Function as a resource person and contact for insurance and other payer sources.

  Transition management to ensure proper patient throughput of patient to next level of care, including home or another facility. Manages the aspects of transition management, including risk identification, implementation of patient-centered discharge plan of care, communication of the discharge plan of care to internal and external stakeholders, and evaluating discharge readiness:

• Promotes collaboration and coordination of health care services and discharge planning for patients and families as they progress along the care continuum. Initiates and maintains communication and collaboration with physicians, primary nurses, care team leaders, staff nurses, social workers, other disciplines and patients/families to develop, implement, and evaluate a patient-centered plan of care.

• Leading the discussion of discharge readiness, identifying and anticipating barriers/variances to the delivery of care and intervenes as necessary.

• Coordinate with Care Teams/Social Work to facilitate alternate care settings when appropriate OR provide identification of patients for whom standard of care treatments could be safely rendered at home. Coordination of authorizations for post-acute services and equipment.

• Validates that elements of the discharge plan have been completed by all internal disciplines and external parties.

• Communicate all elements of the transition plan upon discharge to all stakeholders in a timely, thorough, and accurate manner.

• Complete discharge reviews for all patients using critical nursing judgment and established evidence-based clinical guidelines.

• Directs appropriate parties to disseminate discharge reviews/summaries to payor sources and agencies.

• Functions as a contact for insurance and other payer sources to discharge coordination.

• Participates in the facilitation of hospital to hospital or hospital to facility transfers in a timely manner, minimizing discharge delays.

• Maintains timely documentation in EMR.

  Participate in ongoing professional development activities, making a meaningful contribution to quality improvement and continuing education of self and others:

• Assumes leadership role in the clinical setting.

• Provides clinical consultation to physicians and Children’s Mercy staff regarding coordination of care, case management, and the continuum of care issues in a timely, positive manner.

• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate timely discharges.

• Refers appropriate patients to Social Work for psychosocial intervention, guardianship, financial, resource management and complex discharge planning in a timely manner.

• Demonstrate responsibility, efficiency, good organizational skills, and effective communication skills with internal and external customers.

• Responds to all requests appropriately, accurately, and in a timely manner.

• Understand local, state, and federal regulations, while adhering to organizational policies, rules, and regulations.

• Actively engage in the Children’s Mercy Lean System including participation in huddles, problem-solving methodology, and submission of data as requested.

• Regularly attends and contributes to the success of department meetings, committees, and other CM committee assignments.

• Provides clinical consultation to physicians and Children’s Mercy staff regarding coordination of care, case management, and the continuum of care issues.

• Participates in quality improvement, hospital committees, and/or educational activities within and outside the immediate department.

• Maintains availability for peer consultation and communicates with staff in a timely, effective manner.

• Represents the care management team within the hospital and community to facilitate collaboration.

• Acts as preceptor and mentor to new employees, students, and allied health professionals in the department.

• Assist in the department as requested, shows flexibility in changes in work assignment.

Qualifications

BSN plus 3 years' experience and experience with direct patient care, previous pediatric clinical experience, and ability to navigate EMR and use patient software programs.

One of the following:

• Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire

• Refer to Nursing and Advanced Practice Provider Licensure and Certification policy for required Life Support Certifications Required Upon Hire

  CCM Certified Case Manager OR American Case Management (ACM) Certification Within 3 Years Required

  CPN Certification Preferred

Benefits at Children's Mercy

The benefits plans at Children’s Mercy are one of many reasons we are recognized as one of the best places to work in Kansas City. Our plans are designed to meet the changing needs of our employees and their families.

Learn more about Children’s Mercy benefits. (https://www.childrensmercy.org/careers/why-childrens-mercy/employee-benefits/)

Starting Pay

Our pay ranges are market competitive. The pay range for this job begins at $33.95/hr, but your salaried offer will be determined based on your education and experience.

Remote Work/Work from Home

This is an intermittent remote position, which means that the person hired will work with his or her manager to determine a schedule that includes both at home and on-site hours at a Children’s Mercy location. The incumbent must live in the Kansas City metro area.

EEO Employer/Disabled/Vet

Children’s Mercy hires individuals based on their job skills, expertise and ability to maintain professional relationships with fellow employees, patients, parents and visitors. A personal interview, formal education and training, previous work experience, references and a criminal background investigation all are factors used to select the best candidates. The hospital does not discriminate against prospective or current employees based on the race, color, religion, sex, national origin, age, disability, creed, genetic information, sexual orientation, gender identity or expression, ancestry or veteran status. A drug screen will be performed upon hire. Children’s Mercy is smoke and tobacco free.

Our commitment to Diversity & Inclusion

CM is committed to creating a diverse and inclusive workforce. Our patients and families come from all walks of life, and so do we. We know that our greatest strengths come from the people who make up our team so we hire great people from a wide variety of backgrounds, not just because it’s the right thing to do, but because it makes our hospital stronger and our patient care more compassionate.

If you share our values and our enthusiasm for service, you will find a home at CM. In recruiting for our team, we welcome the unique contributions that you can bring, including education, ideas, culture, ethnicity, race, sex, sexual orientation, gender identity and expression, national origin, age, languages spoken, veteran status, color, religion, disability and beliefs.

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Requisition ID2024-29694

Requisition Post Information* : Posted Date2 weeks ago(6/10/2024 2:49 PM)

Posting CategoryNursing

DivisionCARE MANAGEMENT

Work TypeFull Time

Work DaysTBD

Work Hours0700-1900

FLSA StatusExempt

Location : NameAdele Hall

Recruiter : Full Name: First LastTerry Worthington-Brown

Recruiter : Emailtlworthingtonbro@cmh.edu