Diabetic Care Manager Nurse (Adult & Pediatric)

WVU Medicine

About The Position

The Diabetic Care Manager Nurse comprehensively plans care 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. The position manages transition and discharge planning, evaluates patient progress and needs, coordinates referrals to post-acute services, and communicates plans with patients, families, providers, and the multidisciplinary team. It also conducts clinical reviews, applies utilization criteria, monitors authorization and level of care, supports reimbursement certification, and helps staff understand payer regulations and managed-care principles. The role requires a current Registered Nurse license and three years of clinical experience. A Bachelor of Science in Nursing is preferred. The position is scheduled for 40 hours per week on a day shift, with some weekend coverage required. Work may involve protracted or irregular hours and exposure to biohazards, infectious diseases, water, and electrical hazards associated with patient-care equipment.

Requirements

Current Registered Nurse license issued by the state where services are provided, or a current multistate Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
Three years of clinical experience.
Knowledge of patients’ current medical insurance coverage and limitations, and precertification requirements for durable medical equipment, post-acute placements, infusions, transfers, and related services.
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.
Ability to meet the stated physical demands, including frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling; moving and positioning patients; and heavy work involving exertion of more than 100 pounds occasionally, up to 50 pounds frequently, and up to 20 pounds constantly.
Hearing and visual acuity within the stated normal ranges, including ability to perform night driving as necessary for patient care.

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 processes for the assigned caseload.
Monitor patient progress and intervene as needed to ensure care plans 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 and 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 care, long-term acute care facilities, acute rehabilitation facilities, and skilled nursing facilities.
Communicate transition and discharge plan information to the multidisciplinary team, patient, and family.
Document patient and family interactions, transition and discharge planning activities, and progress in a timely and comprehensive manner according to departmental policy.
Assist patients and families with medical power of attorney, health care surrogate, and advance directive completion.
Collaborate on resource and financial management, including coordination or referral for financial assistance, entitlement programs, and patient benefits.
Use electronic-record quality screens 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 review, and follow up with payors to resolve problems as needed.
Educate hospital staff and physicians about payer regulations and managed-care principles to prevent denials.
Foster the integration of staff and/or students into the healthcare team.
Complete annual education required for specialty accreditation at facilities where such requirements apply.