Case Manager RN - Onsite

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Case Manager RN - Onsite

Macon, GA, United States

Job ID: R227211

Shift: Various

Job Type: Regular

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Department:

34006 Navicent Health Medical Center - Patient Placement

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Mon-Fri 8am-5pm with variable holiday/weekend shifts

On-Site - Macon

Pay Range

$41.10 - $61.65

Major Responsibilities

• Participates in rounds on the patient care unit with the attending physician and other members of the health care team; coordinates communication to assure collaboration and consistency in moving the patient's care to estimated date of discharge.
• Assesses patients to determine their discharge planning and/or post-acute transition needs. Develops the discharge plan and works with the physician to implement the plan utilizing internal and external resources to ensure a safe discharge or transition to alternate level of care. Plan will address the following: assessment of patient's physical, functional, social and psychological status; assessment of cultural and language needs; assessment of caregiver resources and available benefits.
• Assigns the appropriate care pathway based on the clinical feedback from the physician and the diagnosis-DRG. Ensures coordination of services among the patient's physicians, specialists, community agencies and vendors. Works collaboratively with patient's physicians and members of the multidisciplinary team to assure communication and exchange of input related to patient's specific care needs. Utilizes clinical judgment, independent analysis, evidence-based clinical guidelines, patient preference, and input from interdisciplinary team in making decisions.
• Assesses progress toward goals and identifies barriers to meeting goals. Prepares and maintains appropriate documentation of patient care and progress within the designated systems. Closes cases in accordance with defined case closure procedure in a timely manner and in accordance with established guidelines. Refers cases for post discharge follow up to the Care Navigator-Outpatient.
• Advocate in the patient's best interest for necessary funding, treatment alternatives, timelines and coordination of care, with frequent evaluations of progress and goals. Continues to identify community and caregiver resources to ensure continuity of care during and after completion of the care management plan.
• Integrates patient-centered care into the nursing processes to include the patient(s) and family in care decisions, incorporating evidence based practices to achieve safe and effective patient and process outcomes. Communicates plan of care to patient and family and solicits concerns, questions, and issues for resolution.
• Demonstrates customer focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary health care team, community agencies, patients, and families with diverse opinions, values, and religious and cultural ideals.
• Performs Utilization Management duties as indicated by the UM Plan and the payer requirements. Acts as a liaison between the Precert Team and the physician.
• Performs all duties related to utilization review as mandated by Navicent Health UM plan and by regulatory agencies such as DNV, CMS, Payers, DCH, etc.
• Works with Physician to establish the appropriate admission status for billing. Ensures all aspects of the process are addressed from a CMS compliance standpoint. Issues the IMM notice to discharging patient,
• Monitors CarePathways entering clinical information into the system and using an established UR criterion. Makes referrals to the UM Physician Advisors as per policy. Works with Attending Physician to ensure changes to status are supported by order and documentation.
• Track utilization of professional services, service delays, discharge delays, etc and reports as necessary. Provides collaboration with the Attending Physician to work through the delays

Minimum Job Requirements

Education: Completion of an accredited nursing educational program, BSN preferred.

Certification / Registration / License: Current registered nursing license. Eligibility to manage patients in a facility outside of the state of applicable state requires a compact License.

Work Experience: Minimum of three years of recent experience in acute care, home health, case management, discharge planning or care management. Experience as a Care Manager preferred.Experience with IT solutions such as electronic health record, learning management or disease/care management systems a plus.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Coordinates and supports the providers and multidisciplinary team in facilitating patient care, providing ongoing care management services during an acute-care admission as well as continued follow up with the objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care. Provides utilization management, clinical documentation integrity, discharge planning and post-acute care needs assessment and acts as a liaison for utilization management and clinical documentation improvement. Responsible for designated unit-based patient cases and plans effectively in order to meet patient needs, manage the length of stay via monitoring and coordination of care pathways and promote efficient utilization of resources.

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