Registered Nurse - (RN) - Case Manager - PRN

Work Shift/Schedule: 8-hour morning to afternoon shifts, including weekend rotation as needed.

About the Role

Responsible for providing comprehensive assessment, planning, implementation, and overall evaluation of individual patient needs. Works collaboratively with physicians, patient/family, nursing, utilization review, and other members of the healthcare team to ensure patient management aligns efficiently and effectively with patient needs using resources to meet quality, clinical, and cost-effective outcomes. Coordinates a team approach to facilitate achievement of expected patient outcomes with appropriate transitions to the next level of care. Responsible for length-of-stay management, regulatory compliance, and participation in interdisciplinary team rounds on assigned units. Collaborates with community providers to coordinate post-hospitalization care plans. This position involves contact with patients across all age groups: neonate, infant, child, adolescent, adult, and geriatric. Provides cross-coverage for all Registered Nurse Care Managers (RNCM) as required across all settings in the care continuum.

Responsibilities

• Monitor all patients on assigned units to ensure appropriate use of resources and interventions while managing patient length of stay based on working DRG/admitting diagnosis.
• Communicate with physicians, patient/family, and other disciplines regarding expected length of stay and patient progress toward discharge.
• Provide coordination and facilitation oversight of patient care to ensure required interventions occur in proper sequence and processes happen in a timely manner without delays.
• Identify and act on potential delays in services; escalate unresolved delays to management for intervention.
• Assess, coordinate, and facilitate the patient’s discharge plan to ensure post-acute needs are arranged and secured prior to discharge.
• Communicate the discharge plan with physicians, patient/family, and other healthcare team members as appropriate.
• Reassess the discharge plan routinely throughout the patient’s stay to ensure timely, safe discharge and appropriate transition to the next level of care.
• Provide patient/family with information regarding their plan of care, discharge, and any financial responsibility for inpatient or post-hospitalization services.
• Maintain knowledge of reimbursement methodologies and general coverage guidelines for all levels of inpatient and outpatient care; communicate with physicians, patient/family, or team members as needed to ensure service coverage.
• Coordinate and communicate with the Utilization Review Nurse daily to ensure patients are in the correct status and level of care; facilitate changes by communicating with physicians, mid-level providers, or nursing staff as needed.
• Serve as a liaison to patients, families, physicians, nursing staff, and other disciplines to achieve optimal outcomes in discharge planning.
• Act as a leader on assigned units in discharge planning, social service issues, community resources/referrals, and financial information related to patient care and outcomes.
• Empowered to think creatively to develop new, effective solutions to complex problems or opportunities.
• Actively support a customer service-oriented environment to continually enhance service; communicate directly with physicians, nursing staff, patient/family, and other disciplines to ensure collaborative practice.
• Provide appropriate handoff communication as patients transition between units to ensure optimal outcomes.
• Maintain a positive attitude and communicate appropriately with patients, families, physicians, management, and staff; respond positively to change and offer suggestions for incorporating change into daily workflow.
• Maintain detailed knowledge of community resources, governmental regulations, and third-party payers (PPOs/HMOs) to facilitate appropriate outcomes.
• Adhere to all regulatory and DNV requirements; knowledgeable of third-party/governmental payer regulatory requirements and follow appropriate processes.
• Complete required paperwork.
• Demonstrate a "sense of urgency" in work while mindful of financial stewardship opportunities.
• Work all scheduled shifts, including weekend rotation and remote coverage as required.

Requirements

• Licensed to practice as a Registered Nurse (RN) in Georgia.
• Associate’s Degree from an accredited school of nursing.
• Three to five years of experience in direct patient care and/or case management.
• Financial and discharge planning experience.

Preferred Qualifications

• Case Management Certification (CCM) or American Case Management Certification (ACM).
• Bachelor’s Degree.
• Demonstrated aptitude in critical care, cardiac, medical, and/or surgical nursing.
• Working knowledge of state and federal regulations.

Skills

• Excellent observation skills, analytical thinking, and problem-solving abilities.
• Self-directed with strong oral and written communication skills.
• Interpersonal skills including professionalism, teamwork, and a positive approach.
• Ability to think creatively and develop innovative solutions.

Physical Demands

• Weight Lifted: Up to 20 lbs, occasionally (0-30% of the time).
• Weight Carried: Up to 20 lbs, occasionally (0-30% of the time).
• Vision: Moderate, occasionally (0-30% of the time).
• Kneeling/Stooping/Bending: Occasionally (0-30% of the time).
• Standing/Walking: Occasionally (0-30% of the time).
• Pushing/Pulling: Occasionally (0-30% of the time).
• Intensity of Work: Frequently (31-65% of the time).
• Job requires reading, writing, reasoning, talking, and keyboarding.