Case Manager (RN)

Luminis Health • Lanham, MD

9d • $35 - $50

About The Position

The Case Manager works under the direction of the clinical director of care management to coordinate care for Luminis Health patients and support safe, seamless, timely transitions across the continuum. Using a collaborative process, the Case Manager identifies, assesses, plans, implements, and evaluates the options and services needed to address patients’ health and related needs, including social determinants of health. The role promotes appropriate resources at the right time and level of care, engages and supports patients needing care management, determines initial and ongoing levels of care using evidence-based guidelines, and submits appropriate denial reviews for Medicare, Medicaid, and commercial insurers.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The listed duties and requirements are an overview rather than an exhaustive list; supervisors may assign other duties as necessary.

Requirements

• BSN or ADN with equivalent experience; a BSN must be achieved within five years of the role’s start date.
• Three years of experience in a clinical setting, ambulatory care, or post-acute care.
• Current licensure as a registered nurse by the Maryland Board of Nursing.

Nice To Haves

• Care coordination experience.

Responsibilities

• Identify and prioritize patients needing care management using a holistic approach that considers biopsychosocial, functional, cultural, spiritual, and financial factors, and use a multidisciplinary approach to assess and plan care needs.
• Use strategies such as motivational interviewing to promote patient engagement, self-care, treatment adherence, and optimal health and well-being.
• Apply evidence-based guidelines, such as InterQual or other agreed-upon guidelines, to promote quality care, reduce variation, and mitigate waste; verify the appropriate level of care; enter clinical reviews and authorized days in Epic; document actions to avoid denied days; and refer cases to a Physician Advisor when appropriate.
• Manage observation-stay patients assertively and ensure timely testing, treatment, and conversion to inpatient status or discharge.
• Develop and coordinate transition plans for patients moving to home with home health, community care coordination, hospice or palliative care, home infusion, and routine sub-acute and skilled post-acute providers; complete necessary documentation and handovers, and involve and prepare patients and families for transitions from the ED, Peds, Clatanoff, or Observation unit as indicated.
• Maintain clear, concise patient-record documentation of physical and functional limitations, psychosocial characteristics, educational needs, family and social supports, financial and economic circumstances, and transition needs; initiate referrals to other disciplines as indicated.
• Participate in nursing-unit and department clinical outcome projects and care-management process-improvement initiatives.
• Identify patient situations requiring referral to other healthcare team members, including infection control, risk management, or quality management; ensure the plan of care is adjusted and follow-up occurs, and keep leadership informed of potential issues.
• Use risk and predictive analytics tools, including the readmission risk tool, and apply tailored interventions to address barriers and risks, avoid unnecessary prolonged hospitalization, and prevent readmissions.
• Maintain compliance with regulatory standards, including CMS and commercial-insurer requirements.

Benefits

• Medical, dental, and vision insurance.
• Retirement plan with employer match for employees who work more than 1,000 hours in a calendar year.
• Paid time off.
• Tuition assistance benefits.
• Employee referral bonus program.
• Paid holidays, disability, and life/AD&D coverage for full-time employees.
• Wellness programs.
• Employee assistance programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree