Case Manager RN - Per Diem

About the role

The Case Manager RN works in conjunction with the centralized denial prevention team to facilitate the progression of care for hospitalized patients. They collaborate with the interdisciplinary care team to ensure efficient and high-quality care, focusing on patient flow and discharge planning.

Responsibilities

• Screen patients early in the hospitalization and every 1-2 days to facilitate care progression and establish an anticipated length of stay and transition planning needs.
• Collaborate with the medical team to formulate a treatment plan, including care transitions and promoting patient flow.
• Complete an initial assessment of all admissions/observation patients to identify barriers impacting the length of stay and discharge planning.
• Navigate the care delivery system, ensuring appropriate clinical resources and timely tests, treatments, consults, and procedures.
• Articulate the plan of care and communicate it to other care team members and the patient/caregiver. Intervene when deviations occur.
• Create and coordinate the overall transition plan of care, involving social workers, direct care providers, external service organizations, and community care services.
• Facilitate daily Multi-Disciplinary Rounds (MDRs) and communicate the plan to the health care team, estimating the length of stay, care progression barriers, and anticipated disposition.
• Ensure appropriate clinical follow-up and referrals to post-acute providers, and communicate the plan effectively to the patient and family/caregiver.
• Proactively interface with payers to verify coverage/benefits for discharge needs and obtain authorization for post-acute care.
• Identify and initiate appropriate interventions for patients at risk for readmissions and engage community resources as necessary.
• Document care plans thoroughly and communicate them to the interdisciplinary team and the patient/caregiver, identifying and addressing issues affecting patient flow, satisfaction, safety, and outcomes.
• Escalate deviations from the plan to the Physician Advisor as needed.
• Complete PRIs upon request and as needed.
• Maintain and model the organization's values, demonstrating regular attendance, reliability, and adherence to regulatory standards.

Qualifications

• Current NY RN license required.
• Bachelor’s degree in nursing or another healthcare-related field preferred.
• 3-5 years of experience in an acute care setting.
• Preferred certifications: ACM, CCM, or CMAC.
• BLS certification recommended.