Case Manager RN

UnitedHealth Group•Waukesha, WI

9d•$60,200 - $107,400•Onsite

About The Position

The Case Manager RN is responsible and accountable for coordination of patient services through an interdisciplinary process, which provides a clinical and psychosocial approach through the continuum of care. Through concurrent case management, patients will be assessed to determine appropriateness of admission, continued hospitalization, as well as appropriate level of care. Case Managers facilitate timely care delivery at the right time, in the right setting, by following CMS guidelines, escalation of operational barriers, and collaboration with all stakeholders. Discharge planning will begin at the time of (or prior to) admission, and reassessed ongoing throughout the course of hospitalization in partnership with the clinical team, the patient, and/or the patient’s representative. Quality and Risk Management issues will also be monitored and reported as appropriate.

Requirements

Associate's Degree in Nursing
Current, unrestricted RN license in the state of employment
1+ years of experience with/knowledge of community resources, policies, and procedures
1+ years of hospital and inpatient medical/surgical unit experience
1+ years of clinical experience with/knowledge of age groups, including but not limited to the unborn child through geriatric age group
Basic Microsoft Office Skills

Nice To Haves

Bachelor of Science
2+ years of case management experience
Case Management Certification
Strong analytical, critical thinking and organizational skills
Knowledge of Utilization Review, Medicare Requirements processes as well as State and Federal regulations pertaining to Utilization Review and Discharge Planning

Responsibilities

Takes lead role in directing disposition of patients and utilization considerations
Assumes leadership role to facilitate interdisciplinary collaboration
Effectively problem-solves and actively pursues resolution
Directly communicates with staff, physicians, patients, and families
Role models leadership behavior through courtesy, respect, and efficiency
Coordinates patient care processes to achieve desired quality outcomes and identifies/controls inappropriate resource utilization
Facilitates patient and family education and promotes continuity of care to achieve optimal patient outcomes. Assures patient rights by offering a choice when appropriate
Reviews the patient plan of care with the multi-disciplinary team. Facilitates and participates in multi-disciplinary team care conferences for patients with complex problems. Communicates in the medical record and verbally with the team to coordinate interventions and facilitate continuity of care
Daily communication and collaboration with the patient care staff to provide continuous assessment, evaluation, and continuum planning to ensure the patient receives the appropriate level of care at the appropriate time
Functions without direct supervision, utilizing time constructively and organizing assignments for maximum productivity. Arrange schedules to facilitate meetings with physicians for patient care rounds, team meetings and other opportunities to improve communication
Ability to effectively read, write, and speak, cognitively process and emotionally support performing other duties as assigned
Basic Microsoft Office Skills
All employees are expected to remain flexible to meet the needs of the hospital, which may include floating to other departments to assist as patient needs fluctuate
Must be able to functionally coordinate and discharge plan for all age groups, including but not limited to the unborn child through geriatric age groups
The CM will be responsible for integrating the assessment of the need for post-hospital services and determination of an appropriate discharge plan for complex cases
Educates patient/family as to options/choices within the level of care determined to be appropriate. Initiates and ensures completion of all necessary paperwork
Facilitates completion of orders as required prior to transfer of patient to the next level of care in a timely manner so discharge is not delayed
Continuum of Care planning will emphasize education and collaboration with physicians, family members, clinical social workers, nursing staff, therapists, and case managers from contracted payors when appropriate to determine discharge plan that will be of maximum benefit to the patient. Involve staff from the next level of care in the treatment plan as early as possible to promote continuity and collaboration
Develop care plans for patients who frequent the Emergency Department in partnership with the patient’s physician, ED Provider, and community resources
Knowledge of all applicable federal and state regulations. Shows working knowledge of managed care and Medicare health plans and reimbursement related to post-acute services within the continuum of care
Reports on all relevant information on the staff assuming responsibility in the next level of care
Responsible for communicating with the department director LOS and financial information, and issues that may affect the continuum of care process
Adheres to name badge/dress code compliance