Hospice RN Case Manager

About the Role

The RN Case Manager focuses on providing quality and continuity of care for patients while reducing utilization costs. This position directs patients to timely, appropriate healthcare services based on symptoms and medical conditions via phone. It also provides Case Management services to GMG capitated patients, particularly those who are high risk for frequent inpatient or ER encounters or need added expertise to navigate complex treatment plans.

Responsibilities

• Assist in directing patients to the appropriate level or location of care based on history, symptoms, and provider advice (e.g., scheduling appointments with GMG providers, directing to Urgent Care or Emergency Room, or providing standard advice).
• Follow approved triage protocol guidelines set forth by the organization.
• Maintain an accurate database of GMG High Risk patients and review the High Risk census weekly to ensure it reflects appropriate patients, including those with frequent hospital admits/ER visits or other high-risk factors.
• Stratify patients in team meetings to define care needs and frequency for home visits by High-Risk nurses or licensed Social Workers.
• Place timely calls to high-risk patients to assess health status, ensure treatment plans are followed, perform teaching, and monitor outcomes.
• Arrange appropriate acute care and follow-up care with PCPs, Intake, and other GMG or Preferred Providers.
• Assist patients with medication orders, refills, diagnostics, and other identified services.
• Educate patients about disease processes, symptoms, treatments, and provider orders.
• Keep PCPs, clinical, and high-risk care team members informed of pertinent findings or issues.
• Update the daily hospital census and participate in physician communications (e.g., email, meetings) to monitor the clinical picture and plan for patients.
• Ensure patients have prompt hospital follow-up appointments to help prevent readmission.
• Assess discharge status, level of understanding, and compliance; monitor attendance and follow up on "no shows" and cancellations.
• Attend Patient Care Committee and High-Risk Team meetings to provide follow-up case management and address special care needs.
• Assist with setting up complex services for other patients as needed (e.g., SNF, custodial care, psychiatric services, IV treatments).
• Review HH/DME forms and ensure services are authorized before provider sign-off.
• Document appropriately in GMG computer systems, high-risk databases, and other associated systems.
• Successfully meet care coordination and nurse triage production goals.
• Perform other duties as assigned.

Requirements

• Perform all duties accurately and in a timely manner.
• Develop and maintain supportive, productive, and effective relationships with external and internal partners.
• Excellent written and verbal communication skills.
• Strong attention to detail and exceptional organizational skills.
• Maintain strict confidentiality of company, department, and patient information.

Qualifications

• Minimum high school education or equivalent required; graduation from an approved BSN program.
• State-licensed RN with a minimum of three years of RN experience (clinic experience preferred).
• Prior managed care experience preferred.
• Knowledge of medical terminology.
• Excellent customer service skills.
• Must keep all licenses and certifications current and in good standing, as continued employment is contingent on these credentials.