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. This role supports efficient, high-quality care through collaboration with the interdisciplinary care team.

Responsibilities

• Screen patients early in the hospitalization and every 1-2 days to facilitate care progression and discharge planning.
• 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.
• Create and coordinate the overall transition plan of care, involving social workers, direct care providers, and external service organizations.
• Facilitate daily Multi-Disciplinary Rounds (MDRs) and communicate the plan to the health care team.
• Apprise the interdisciplinary team of the estimated length of stay, care progression barriers, and anticipated disposition.
• Identify and initiate appropriate interventions for patients at risk for readmissions.
• Document case management assessments and care plans in a thorough and timely manner.
• Escalate deviations from the plan to the Physician Advisor as necessary.
• Communicate the plan effectively with the patient and family/caregiver, ensuring they have resources for success post-discharge.
• Manage quality indicators and suggest strategies to improve organizational/departmental performance.
• Assist with completion of PRIs upon request and as needed.

Requirements

• Minimum formal education of Associate Degree in Nursing and minimum of three years job-related experience.
• Registered Nurse license State of CT with minimum of one year as an acute Care Coordinator.
• Knowledge and expertise with electronic medical record and use of Interqual and Milliman screening criteria.
• Excellent collaborator and team member with strong communication skills.
• Knowledge and expertise in CMS and insurance industry standards.
• Ability to be flexible, resourceful, and creative in problem-solving.

Experience

• Certification in Case Management preferred or willing to obtain.
• Bachelor's Degree in Nursing preferred.