Case Management - RN

Nemours Children's Health•Orlando, FL

17h

About The Position

Under the general direction of the Director, Manager, and Lead/Supervisor Case Management RN, the Case Management RN coordinates all aspects of discharge planning for admitted patients in collaboration with the interdisciplinary care team. The role promotes patient- and family-centered care through screening, assessment, ongoing monitoring, and interventions that advance the progression of care. The CM RN works to improve outcomes by coordinating appropriately timed discharges, reducing readmissions, and improving patient and family satisfaction. The role incorporates ethical and legal principles into its essential functions, using the Standards for Case Management as a framework. Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters each year. It delivers care across six states through two freestanding children's hospitals, a network of more than 80 primary, urgent, and specialty care practices, and more than 40 hospital partnerships. The $1.7 billion nonprofit system is backed by the Nemours Foundation and Alfred I. duPont Trust and is dedicated to improving children's health through clinical care, research, education, advocacy, and prevention. Its Whole Child Health approach focuses on prevention and treatment and partners with communities to help every child thrive. Nemours is committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued.

Requirements

RN/ASN required from an accredited school of nursing.
Active Florida or multistate RN license required.
Minimum of 3 years of nursing experience required.
American Heart Association BLS required within 30 days of hire.

Nice To Haves

BSN preferred.
Professional certification in case management, certified managed care nursing, or an area of clinical specialty preferred.
Related clinical experience preferred.

Responsibilities

Assess new patients by gathering information, reviewing diagnoses, and analyzing medical test results to anticipate discharge needs.
Complete and document an initial discharge planning assessment for all inpatients upon admission in collaboration with the Social Worker, verifying demographics and insurance.
Process home health orders and case management referrals for post-acute care plans in a timely manner, including home health services, durable medical equipment, home infusion therapies, appointment scheduling, and transfers to other facilities or levels of care.
Communicate with the care team to confirm a discharge plan and expected discharge date, monitor ongoing progression, and report resource limitations that could affect the plan.
Educate providers and clinical staff about resources available for a safe discharge, including managing provider expectations.
Attend and actively participate in discharge planning rounds, weekly complex case reviews, and care conferences.
Coordinate discharge planning arrangements, transportation needs, letters of medical necessity, and regulatory requirement forms with the home care coordinator and social worker.
Participate in medication discussions and ensure patients can obtain prescriptions, assisting with obtaining resources when appropriate.
Communicate directly with patients and families about the discharge plan and verify their understanding and agreement before discharge.
Communicate and collaborate with Utilization Management regarding patient status, changes in the plan of care, and risk for denials.
Identify high-risk patients through the initial admission assessment and create a collaborative plan to address their unique needs.