Registered Nurse Case Manager (RN)

About the role

A professional nurse with advanced clinical knowledge and skills, gained through education and in-depth clinical experience, will provide case management to targeted populations. This role coordinates and facilitates the patient’s hospitalization from pre-admission through post-discharge, collaborating with physicians, nurses, social workers, and other health team members to expedite medically appropriate, cost-effective care. The position applies clinical expertise and medical appropriateness criteria to resource utilization and discharge planning, aiming to achieve desired health maintenance and disease prevention outcomes. The role advises the healthcare team and provides leadership as necessary, communicating across departments to improve clinical management of patients and impact medical and psychosocial care across the healthcare continuum. Core processes include risk assessment, discharge planning, and utilization management.

Responsibilities

• Using established criteria, review the appropriateness of a patient’s admission, need for continued stay, and information needed for discharge.
• Discuss estimated length of stay, treatment, and discharge plan with the attending physician, as indicated.
• Initiate discharge planning by assessing the patient’s needs and documenting the assessment on the interdisciplinary plan of care.
• Interview patient, family, and appropriate health team members to develop a discharge plan that incorporates patient choice and is clinically appropriate, cost-effective, and safe.
• Ensure the interdisciplinary care plan and discharge plan are consistent with the patient’s clinical course, continuing care needs, and covered services.
• Refer complex discharge planning issues to other members of the case management team as directed by referral criteria.
• Provide leadership to the healthcare team to implement the discharge plan and facilitate patient transfer to the next level of care when medically able.
• Obtain third-party payer certification due to patient status change and information needed for discharge.
• Conduct interdisciplinary rounds.
• Discuss with the attending physician and/or physician advisor the appropriateness of resource utilization, consultation, and treatment plan.
• Collect data on variances from quality screening criteria by the Clinical Excellence Council and report quality concerns to Quality Assurance.
• Continually ensure and enhance quality outcomes.
• Respond to third-party requests for concurrent clinical information and complete all necessary forms in a timely manner.
• Act as a liaison/patient advocate and influence interactions to ensure high-quality patient care.
• Coordinate appropriate educational material/instruction for patients, families, medical staff, and multidisciplinary personnel to accomplish patient care outcomes.
• Maintain cost-effective utilization of care continuum resources.
• Coordinate with staff to develop a mechanism to monitor patient progress against guidelines and evaluate variances for individual patients and targeted populations.
• Identify possible delays and avoidable days; work with providers to prevent delays and identify system/provider opportunities for improvement.
• Perform other duties as assigned.

Requirements

Minimum Requirements

• Education: Associate’s degree in nursing or related field, or equivalent combination of work experience and education.
• Experience: Recent acute care experience.
• Licensure/Certifications:
  • Valid current Arizona Nursing License or compact state license, with ability to become Arizona licensed within 30 days.
  • Basic Life Support (BLS) – American Heart Association.
  • Advanced Cardiac Life Support (ACLS) – American Heart Association.
  • Pediatric Advanced Life Support (PALS).
  • Crisis Prevention Institute (CPI).
  • NIH Stroke Scale (NIHSS) and others as required by individual department.

Preferred Requirements

• Education: Bachelor’s Degree in Nursing.
• Experience: Combined bedside and care management experience.
• Licensure/Certifications: Certification in specialty area and/or Case Management.

Benefits

The hospital offers a comprehensive benefits package prioritizing health, professional development, and work-life balance, including:

• Medical, dental, vision, and life insurance.
• 401(k) retirement savings plan with employer match.
• Generous paid time off.
• Career development and continuing education opportunities.
• Health savings accounts, healthcare, and dependent flexible spending accounts.
• Employee Assistance Program and employee discount program.
• Voluntary benefits, including pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder and childcare, auto, and home insurance.

Note: Eligibility for benefits may vary by location and is determined by employment status.

About the organization

St. Mary’s Hospital, established in 1880, is Southern Arizona’s longest continually operating hospital and one of the top medical centers in Tucson and the region. Home to the Carondelet Heart & Vascular Institute, St. Mary’s is recognized as a destination hospital for minimally invasive heart and vascular surgery, as well as advanced stroke care, emergency care, wound care, and bariatric surgery. The hospital strives to offer personalized, compassionate care to every patient.