Sr. RN Care Manager

Demonstrated Skills

Demonstrates the knowledge base and essential psychomotor skills required to effectively carry out the job.

Demonstrates the ability to interpret, analyze, and apply relevant data to prioritize and determine a course of action appropriate to meet patients’ management needs.

Demonstrates effective communication and collaboration with culturally and professionally appropriate interpersonal skills.

Demonstrates effective time management and the initiative to carry out job responsibilities in a timely manner.

Effectively assesses, plans, implements, and evaluates strategies that ensure appropriate utilization of clinical resources and management of length of stay.

Effectively assesses, plans, implements, and evaluates the effectiveness of discharge plans for the assigned caseload of patients.

Maintains all organizational requirements and demonstrates initiative to establish and achieve personal and professional goals.

Demonstrates effective customer service behaviors as defined by the organization’s mission, vision, and values.

Creates and implements a discharge plan for every admitted patient.

Affords each patient a thorough assessment of their medical, functional, psychosocial, legal/financial, and safety status, including self-care and environmental factors.

Tailors discharge plans to patients' needs and problems.

Collaborates with physicians, nurses, and other multidisciplinary team members to make recommendations for effective, appropriate patient management.

Comanages patient caseloads on a continuous basis in partnership with Social Worker Case Managers.

Identifies and addresses patients’ and families’ needs related to social determinants of health (SDOH), and refers to appropriate resources such as community agencies, private caregivers, behavioral health and psychosocial services, transportation assistance, medical and housing support, and educational materials.

Implements discharge plans and referrals to services.

Identifies and resolves delays and obstacles to discharge, serving as the primary leader of the discharge process.

Monitors patient length of stay and utilization of ancillary resources on an ongoing basis.

Identifies avoidable days and opportunities for process improvement and recommends actions to optimize efficiency and resource use.

Communicates following the chain of command regarding appropriate utilization of resources, physician concerns, and length of stay activities.

Provides information as required regarding denials/approvals.

Expedites the peer-to-peer process through collaboration with physicians and insurance companies for post-acute activities.

Communicates denials to patients, families, and physicians as needed, specific to post-acute services.

On a concurrent basis, enters all pertinent data (discharge plans) in data collection systems per policy and established process.

Participates in clinical performance improvement activities as needed and as assigned.

Completes readmission interviews with patients/families to help determine causes of readmission and enters information into appropriate systems.

Understands the intricacies of and can interpret/negotiate with state, local, and federal agencies to optimize placement of patients in the most appropriate setting.

Assesses and aligns patients’ needs with placement options consistent with desired levels of care.

Works within CMSA Standards of Practice.

Serves on committees to promote advancement of organizational and departmental operations and practices.

Attends educational trainings and reports back to the department on best practices and key takeaways.

Works alongside the Lead Trainer Case Manager to serve as a primary preceptor for new hires and a mentor for other Case Managers.

Owes a departmental project that drives measurable outcomes and results for the department and organization.

Emergency Department Gatekeeper Responsibilities (as assigned): May serve as the Emergency Department (ED) Gatekeeper RN Case Manager as assigned, supporting appropriate patient placement, admission necessity, and transitions of care in accordance with ACMA standards and hospital utilization policies.

Conducts real-time clinical reviews to determine admission, observation, or outpatient status using evidence-based criteria (e.g., InterQual, MCG), escalating complex cases to the physician advisor as appropriate.

Facilitates early identification of discharge needs and barriers, addressing SDOH factors and coordinating with internal and community resources to prevent unnecessary admissions or readmissions.

Collaborates with ED physicians, nursing, bed control, and inpatient case management to support hospital throughput, timely disposition, and optimal use of resources.

Participates in multidisciplinary huddles and rounds to identify high-risk patients, enhance communication, and promote seamless transitions of care across departments.

Other duties as assigned.

Education And Experience

• Minimum Required Education: Bachelor of Science in Nursing (BSN).
• Master’s degree in related field preferred.
• Experience: Minimum of Five (5) years of clinical nursing experience with three (3) years of case management experience required.
• Must demonstrate strong critical thinking and case management skills.
• Strong understanding of discharge planning, utilization review, and transitional care principles.
• Experience with CMS regulations, commercial payer guidelines, and accreditation standards (DNV, TJC).
• Proficiency in clinical decision tools (e.g., MCG, InterQual) and electronic health records (EHR).

Required Certifications, Licenses, and Registrations

• Prior leadership, charge, preceptor, or trainer experience preferred.
• Active RN Licensure for the state of Virginia required.
• Obtain CPR certification within 6 months and maintain CPR certification by following hospital policy for renewals reference the RQI policy.
• Case Management Certification required through ACMA or CCM.