Registered Nurse (RN) Case Manager

Job Responsibilities

• Collects delay and other data for specific performance and/or outcome indicators.
• Affords support in the collection and reporting of resource and financial indicators including acute and post-acute case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
• Collaborates with the interdisciplinary healthcare team, patients and families in the assessment and coordination of discharge planning needs, delivery of post-discharge planning needs, delivery of post-discharge services and transition of patients from hospitals to the discharge setting as well as ongoing care in the community.
• Documents relevant discharge planning information in medical records according to department standards and/or care management plans.
• Collaborates/communicates with internal and external case managers. Understands pre-acute and post-acute resources.
• Provides coordination of services and acts as a key Liaison between patients, families and the interdisciplinary healthcare team members.
• Works holistically to ensure that healthcare plans and discharge plans meet the physical, social and emotional needs of patients.
• Provides educational resources and/or referrals to patients and patients' families to address identified needs such as social or financial.
• Acts as an advocate for patients to resolve barriers to care progression.
• Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities.
• Discusses payer criteria and issues on a case by case basis with clinical staff and follows-up to resolve problems with payers as needed.
• Applies approved clinical criteria to monitor appropriateness of admissions, continued stays or post-acute setting appropriateness and documents findings based on department standards.
• Identifies at risk populations by using approved screening tools and following established reporting procedures.
• Makes ongoing monitoring of LOS and ancillary resource use, depending on inpatient stay or outpatient program criteria, on an ongoing basis and takes actions to achieve continuous improvement efficiencies in both areas.
• Refers cases and issues appropriately to resolve barriers to care progression.
• Assesses patients' clinical and psychosocial needs through review of patient information, personal contact with patients/families and interdisciplinary healthcare team members.
• Communicates routinely with patients, families, interdisciplinary healthcare team members and other appropriate parties with regard to the status of patients' care plans and progress toward treatment goals, identification of concerns and/or problems, problem solving and assisting with conflict resolution when necessary.
• Works with the multidisciplinary team to address/resolve system problems impeding diagnostic or treatment progress.
• Sets up consultations with appropriate disciplines/departments as required to expedite care and facilitate discharge.

Qualifications

• Certification: Basic Life Support (American Heart Association)
• Licensure: Licensed or eligible for licensure in the Commonwealth of Virginia as a Registered Nurse or an active multi-state Registered Nurse license
• Experience: 1 year of case management and/or clinical care experience
• Education: Bachelor's Degree Nursing or Associate's Degree. If RN has an Associate's Degree, within 2 years of date of hire, they must meet with their nurse leader and conduct the following: 1.) Identify which accredited school they plan to attend 2.) Provide a written plan with anticipated BSN completion date 3.) Submit a review of transcripts from the school indicating the required pre-requisites and timeline for taking the courses 4.) Complete BSN within 5 years of start date.
• Preferred Qualifications: One (1) year of previous Inpatient (hospital) case management experience and case management discharge planning is highly preferred.