RN Case Manager - Case Management

About the Role

The case manager is responsible for individualized management of hospital and healthcare services necessary and appropriate to the provision of high quality, cost-effective patient care. They work with acutely ill and/or high-risk clients ranging in age from newborn to the geriatric population. The Case Manager develops collaborative, outcome-oriented plans of care for each patient, acts as a patient advocate, and provides mechanisms and support to empower patients to make responsible healthcare decisions while guiding appropriate utilization of resources and services to achieve expected outcomes.

Responsibilities

• Determines appropriate level of care on admission using hospital-approved medical necessity criteria
• Performs patient and caregiver assessments to identify pertinent problems/needs
• Organizes assessment data into an individual plan of care, with anticipated outcomes
• Determines continued stay status
• Participates in multidisciplinary rounds
• Participates in patient education
• Tracks and manages potential avoidable hospital days
• Provides clinical information to external providers and managed care organizations
• Assists in discharge planning
• Assists in appeals and denials management

Requirements

• Graduate of an accredited school of nursing and licensed in the state of Ohio
• 2 years of clinical experience in an acute care setting
• Critical care/emergency department experience highly desired
• Knowledge of evidence-based practice and disease management protocols
• Utilization review and/or discharge planning experience preferred
• Excellent verbal and written communication skills
• Excellent computer skills

LMH is accredited by DNV and TJC, and as such, may require specific annual education related to specialty certifications and standards.