Job Title: RN Case Manager
Profession: Nursing
Specialty: Case Management
Duration: 13 weeks
Shift: 5x7.5 DAYS
Hours per Shift: 7.5
Experience: Minimum three (3) years in one or more of the following: Acute Care, Medical Surgical, Intensive Care, Emergency Department, Community Nursing (Home Care)
License: Current RN License
Certifications: BLS, ACLS, Certified RN Case Manager
Must-Have: Bachelor’s Degree in Nursing (BSN)
Description:
Case Managers are expected to have strong clinical backgrounds and advocate for safe, timely adherence to executing the patient plan of care.
Job training is available in addition to meeting the core qualifications for this position.
Performs face-to-face visits with patients that need assessment of physical, mental, and emotional barriers that prohibit self-care.
Provides prompt medical management assistance in the community and initiates referrals to social work by using nursing clinical judgment.
Functions as an interdisciplinary care team member responsible for daily electronic health record review of patients' medical necessity.
Engages in bedside rounds or interdisciplinary team rounds.
Collaborates with social workers on identifying any social determinants of health that could impede patient health outcomes.
Acts as a liaison between Physicians and Physician Advisors.
Demonstrates the ability to correlate medical necessity in achieving financial and quality care outcomes.
Monitors electronic health records daily or as needed and completes clinical documentation for submission to insurance companies.
Reviews all admissions for medical necessity and submits required documentation to third parties.
Communicates with attending physicians on admission guidelines.
Provides real-time interventions to prevent delays and ensures compliance with healthcare regulations.
Informs treatment team members of recommended documentation needed for approval of admission, transfer, and discharge planning.
Identifies tests, procedures, and interventions early to advance the plan of care.
Assesses and collaborates with the healthcare team on the need for Alternate Level of Care designation.
Documents when a patient is placed on Alternate Level of Care.
Assesses current support and adherence to medical care in the community, evaluating effectiveness towards health promotion.
Collaborates with treatment team members to create a care plan to reduce re-admission rates by identifying barriers to care.
Responsible for completion of home infusion and related home care referral for patients.
Makes appropriate referrals to financial services prior to discharge.
Discusses discharge planning with the treatment team and documents all activities in the electronic medical record.
Follows provider recommendations for discharge planning including facility placement and home with services.
Arranges for community services prior to discharge to meet patient's post-discharge needs.
Updates or modifies the plan of care according to recommendations to facilitate safe and timely discharges.
Communicates patients' discharge plans to the nursing staff.
Advocates for patients with other healthcare disciplines and community agencies to facilitate access to appropriate resources.
Mandates reporting of suspected abuse in all patient populations.
Demonstrates strong written and verbal communication skills.
Participates in professional development activities to maintain licensure and remain current in the field.
Adheres to relevant ethical and professional standards.
Incorporates customer service goals in developing departmental policies and systems.
Continuously reviews the service delivery process to exceed customer expectations.