Case Manager - RN

Rochester Regional Health

8d•Onsite

About The Position

SUMMARY: The Care Manager is working collaboratively with the multidisciplinary healthcare team to ensure the appropriate allocation of hospital resources while maintaining the quality of care. The Care Manager actively participates in the utilization management process using standards of care to determine the most appropriate level of care, participating in the development of plans for care, managing the care across the continuum to ensure a safe discharge in a timely manner.

Requirements

Requires an Associate’s Degree in Nursing (ASN) or a Bachelors in Nursing (BSN). The BSN is preferred but not required.
AAS degree in Nursing required for all Care Managers hired prior to August 1st, 2013.
Registered Nurse with current New York State License

Nice To Haves

3 years of acute hospital care, Nursing, Case Management, or Utilization Management experience preferred.
Case Management Certification Preferred.

Responsibilities

Using nationally recognized standards of care and guidelines, evaluates hospital admissions to assure care is medically necessary and delivered at the most appropriate level.
Actively participates in the concurrent review process and communicates and intervenes with third party payors to ensure reimbursement for services provided while maintaining the quality of care.
Collaborate with providers, patients and families to address concerns and identify safe effective discharge plans. Intervenes to identify and facilitate early referral for discharge planning.
Facilitates the discharge process by identifying and intervening with the health care team to identify alternative solutions to minimize system delays while ensuring a safe discharge plan.
Coordinates and participates in the development, implementation and revisions of evidence based clinical pathways and guidelines.
Participates in driving clinical and administrative compliance with care guidelines and core measures. Identifies and recommends actions for improvement.
Maintains accountability to hospital, state, and federal regulations, and professional standards. Initiates alternate level of care determinations in compliance with regulatory and contractual agreements.
Actively participates in analysis of utilization and quality trends and makes recommendations to management on opportunities for improvement.
Manages confidential information in accordance with RGHS policy and procedures.
Requires flexibility to work across multiple acute care units as needed.
Performs other duties as required.