PRN/Casual Case Manager (RN or Social Worker)

WVU Medicine

11d

About The Position

The Case Manager comprehensively plans for targeted patient populations and performs resource management, including denial management, utilization management, access to the appropriate level of care, discharge planning, care facilitation, and referrals to other levels of care. The role works collaboratively with the multidisciplinary care team to help achieve desired treatment outcomes. This position is listed as PRN/Casual and has 8 scheduled weekly hours. The position requires a current Registered Nurse license issued by the state where services are provided or a current multistate RN license through the enhanced Nurse Licensure Compact, and five years of clinical experience. A Bachelor of Science in Nursing is preferred.

Requirements

Current Registered Nurse license issued by the state in which services will be provided, or a current multistate Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
Five years of clinical experience.
Knowledge of patient medical insurance coverage and limitations, and precertification requirements for durable medical equipment, post-acute placements, infusions, and transfers.
Knowledge of relevant scientific principles, established standards of care, and/or research findings.
Knowledge of procedures and techniques involved in administering routine and special treatments to patients.
Knowledge of and appropriate application of the nursing process.
Knowledge of professional theory, practice, and procedure.
Ability to communicate clearly with patients, families, physicians, and other employees.

Nice To Haves

Bachelor of Science in Nursing (BSN).

Responsibilities

Manage all aspects of transition and discharge planning for assigned patients in a timely manner.
Collaborate with multidisciplinary team members to facilitate transition and discharge planning for the designated caseload.
Monitor patient progress and intervene as appropriate to help ensure the care plan and services are patient-focused, high-quality, efficient, and cost-effective.
Educate staff, physicians, patients, and families as needed to support effective transition planning.
Meet with patients and/or families to assess needs and develop individualized transition or discharge plans in collaboration with the physician team.
Communicate complex family dynamics that may affect care or transition planning to the multidisciplinary team and post-acute providers, when applicable.
Initiate and facilitate referrals to post-acute services, including home care, durable medical equipment, hospice, long-term acute care, acute rehabilitation, and skilled nursing facilities.
Communicate relevant transition and discharge plan information to the multidisciplinary team, patients, and families.
Document patient and family interactions and transition or discharge planning activities and progress promptly and comprehensively, according to departmental policy.
Assist patients and families with completing medical power of attorney, health care surrogate, and advance directive documents.
Collaborate on resource and financial management, including financial assistance, entitlement program, and patient benefit coordination or referrals.
Use quality screens in the electronic record to identify potential issues, including avoidable delays and readmissions.
Complete clinical reviews for patients.
Apply approved utilization criteria to determine medical necessity for admissions and continued stays, and document findings according to departmental standards and policies.
Screen for appropriate authorization and level of care.
Facilitate covered-day reimbursement certification for assigned patients; discuss payer criteria and issues with clinical staff, including peer-to-peer matters, and follow up with payers to resolve problems as needed.
Educate hospital staff and physicians about payer regulations and managed care principles to help prevent denials.
Support the integration of staff and/or students into the healthcare team.
For facilities with specialty accreditation requirements, complete annual required education related to specialty accreditation.