Case Reviewer - Registered Nurse - Clinical Resource Utilization Management

Purpose

Reports to the Manager of Clinical Resource Utilization Management (CRUM) with matrix reporting to the Patient Care Manager of their assigned unit(s).

The Case Reviewer is pivotal in ensuring patients receive efficient, well-coordinated care from pre-admission to discharge. This involves daily evaluation and planning with the interdisciplinary team to assess treatment plans and goals, ensuring appropriate care and early identification of barriers to discharge. Collaborating closely with the team, they facilitate access to treatments and diagnostics, enhancing communication and safe, timely discharge coordination. Additionally, the Case Reviewer actively identifies areas for improvement in care delivery, this involves identifying trends, analyzing data, and proposing solutions to elevate patient outcomes and streamline processes.

Duties

• Participate and collaborate with other health care providers in the provision of patient care.
• Effectively use the Standards of Nursing Practice and the nursing process to assess, plan, implement, and evaluate patient care.
• Provide health teaching to patients and family.
• Compliant with legislation, and organizational and departmental policies, standards, and procedures.
• 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.
• Demonstrate excellent interpersonal and conflict resolution skills.
• Participate in ongoing quality improvement and risk management activities.
• Maintain current knowledge of best practices and benchmarks for the delivery of services, appropriate research, literature, accreditation requirements, and implementing improvements/changes as appropriate.
• Participate in daily bullet rounds identifying readiness for discharge barriers.
• Participate in interdisciplinary rounds and Alternative level of care processes.
• Engage with community partners to support and create supportive and safe plans
• Work with interdisciplinary team to create estimated discharge dates based on evidence based best practices.
• Coordinate and lead patient/family care conferences in collaboration with the inter-professional team.
• Champion patient-centred care by actively involving patients, family/caregiver in decision making process.
• 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.
• Engage as an active member of the interdisciplinary team on their assigned unit.
• Ensure documentation meetings College of Nursing practice standards. Ensure daily monitoring and timely recording of patient service level changes.
• Maintain ALC tracking reconciliation to assist with prioritization of transfers an ALC escalation process.
• Communicate discharge information to patients and family
• Communicate and record expected discharge date in collaboration with the inter-professional team.
• Completion of Health Assessments.
• Maintain financial accountability by accurately recording and tracking requests related to patient care, ensuring adherence to budgetary constraints and resource utilization guidelines.
• Other duties as assigned.
  
  

Qualifications

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

Experience

• Minimum 5 years recent (within 2 years) clinical experience in a hospital inpatient setting.
• Experience in patient system navigation.
  
  

Skill/Ability

• Competency in nursing care appropriate to acute/post-acute hospital settings.
• Knowledge of patient care requirements and specialized equipment.
• Demonstrated ability to facilitate difficult conversations.
• Strong interpersonal and facilitation skills.
• Excellent organizational skills with the ability to meet multiple deadlines.
• Effective communication skills, both verbal and written.
• Human relations skills including empathy, sensitivity, and motivational techniques.
• Critical thinking and problem solving skills.
• Ability to work effectively in a fast-paced environment and stressful situations.
• Computer literacy in a Microsoft environment.
• Ability to maintain successful working relationships with an interdisciplinary team to achieve positive patient outcomes.
• Ability to organize time effectively.
• Advanced knowledge of available services in hospital and in the community.
• Advanced knowledge of relevant Ministry of Health policy decisions
• Ability to meet and interact with people in a pleasant, professional, responsible and reassuring manner.
• 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.

Nurses will be selected on the basis of their skill, ability, experience and qualifications as identified in the resume which they have attached to the posting application form. The Hospital reserves the right to conduct a formal interview and/or testing where required.