Registered Nurse (RN)-Hospital Case Manager, PRN, Days

About the Role

Integral care team partner that focuses on patient engagement and activation, with primary accountability for patients' care transition out of the acute care setting and positively impacting longitudinal care plan alignment. In collaboration with physicians, leads the multidisciplinary team including clinical staff and payors to ensure efficient delivery of quality, cost-effective care. Leads the team for each patient individually with the goal to maximize autonomy where possible.

Responsibilities

• Partners with attending providers throughout hospitalization to promote effective and efficient utilization of clinical resources, ensuring quality, cost-effective care.
• Anticipates next steps and facilitates communication to maximize care efficiencies for the patient and family.
• Identifies social determinants of health that increase the patient's risk for negative outcomes.
• Ensures clear documentation for the interdisciplinary care team and coordinates post-acute plans with the ambulatory care management team as appropriate.
• Facilitates patient access to resources and relevant services.
• Addresses and resolves system problems impeding diagnostic or treatment progress.
• Proactively identifies, resolves, and documents delays and obstacles on the patient's behalf.
• Drives change by identifying areas where performance improvement is needed.
• Navigates value-based care with expertise and ensures the longitudinal plan is patient-focused and aligns with patient and caregiver goals.
• Assesses patients’ and family’s psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness, and ability to cope.
• Maintains expert-level knowledge of body systems and expected clinical outcomes for patient disease processes.
• Maintains current knowledge of changes in state and federal regulatory requirements related to the provision of care management services in an acute care setting.
• Maintains care management knowledge to provide services in accordance with standards of practice as established by the department and management.
• Ensures medical necessity, appropriate level of care, and timely implementation of the plan of care in accordance with the hospital(s) Utilization Review Plan.
• Navigates the team through complex compliance, regulatory, and insurance requirements.
• Coordinates with third-party payors on a regular basis.
• Serves as a resource for patients and families regarding their rights and responsibilities, including when payment of care is denied or when care is no longer medically necessary (e.g., delivery of regulatory documents as provided by CMS).
• Advocates for patient and family empowerment and independence to make autonomous healthcare decisions and access needed services within the healthcare system.
• Performs other duties as assigned.

Requirements

• Bachelor's degree in Nursing.
• Three (3) years of acute care nursing experience.
• One (1) year of acute care case management experience preferred.
• In lieu of the BSN requirement, a nursing diploma or an Associate degree in Nursing may be considered if the applicant signs a BSN Memorandum of Understanding (MOU) agreeing to enroll in an accredited BSN or MSN program within one year and obtain a BSN or MSN degree within four (4) years of hire date. Employees must demonstrate sufficient progress annually toward obtaining an accredited BSN or MSN degree to remain eligible for employment.
• Employees in this title prior to 10/24/2021 are grandfathered and are only required to have an ADN or Nursing Diploma.

Qualifications

• Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification is preferred.

Skills

• Knowledge of Medical Necessity Criteria preferred.

Schedule

Day shift

Location

Richland Hospital, Richland Facility