Case Manager - Part Time

Under the direction of the clinical director of care management, coordinates care for patients at Luminis Health to support safe, seamless, timely transitions across the continuum. Uses a collaborative process to identify, assess, plan, implement, and evaluate options and services required to meet an individual’s health and health-related needs, including social determinants that affect overall well-being.

Responsibilities

• Identifies and prioritizes patients in need of care management services using a holistic approach inclusive of biopsychosocial, functional, cultural, spiritual, and financial factors; employs a multidisciplinary approach to assess and plan for care needs.
• Implements strategies such as motivational interviewing to promote patient engagement, self-care, treatment adherence, and optimal levels of health and well-being.
• Utilizes evidence-based guidelines (e.g., InterQual) to promote quality care, decrease variation, and mitigate waste.
• Verifies appropriate level of care; enters clinical review and authorized days in Epic; documents actions to avoid denied days; refers cases to Physician Advisor as appropriate.
• Manages observation stay patients assertively, ensuring timely testing, treatment, and conversion to inpatient status or discharge.
• Develops and coordinates transition plans for patients moving to home health, community care coordination programs, Hospice or Palliative care, home infusion, and routine sub-acute and skilled post-acute providers; completes all necessary documentation and handovers.
• Prepares patients and families for transitions from the ED, Peds, Clatanoff, or Observation units as indicated.
• Maintains clear and concise documentation in patient records reflecting physical and functional limitations, psychosocial characteristics, educational needs, family/social support systems, financial and economic status, and transition needs.
• Initiates referrals to other disciplines as needed.
• Participates in nursing unit and department clinical outcome projects, as well as process improvement initiatives for care management.
• Identifies potential or current patient situations requiring referral to other healthcare team members, such as infection control, risk management, or quality management.
• Ensures the plan of care is adjusted as appropriate and follow-up occurs; keeps leadership informed of potential issues.
• Utilizes risk and predictive analytic tools, such as readmission risk tools, and applies tailored interventions to mitigate barriers, prevent prolonged unnecessary hospitalization, and reduce readmissions.
• Maintains compliance with all regulatory standards (CMS, commercial insurers, etc.).

Requirements

• BSN or ADN with equivalent experience; BSN must be achieved within 5 years of start date in the role.
• Three years of experience in a clinical setting, ambulatory, or post-acute care.
• Current licensure as a registered nurse by the Maryland Board of Nursing.
• Care coordination experience preferred.

Working Conditions

• Reasonable expectation of exposure to blood-borne pathogens.
• Physical demands: Medium work (lifting, carrying, or otherwise moving objects up to 50 pounds).

Pay

$35—$50 USD per hour.

Benefits

• Medical, Dental, and Vision Insurance.
• Retirement Plan (with employer match for employees who work more than 1,000 hours in a calendar year).
• Paid Time Off.
• Tuition Assistance.
• Employee Referral Bonus Program.
• Paid Holidays, Disability, and Life/AD&D for full-time employees.
• Wellness Programs.
• Employee Assistance Programs.

Benefit offerings based on employment status.