Inpatient Care Manager NEX

Advocate Health and Hospitals Corporation • Charlotte, NC

4d

About The Position

The Inpatient Care Manager conducts patient assessments, establishes care plans, and initiates interventions within appropriate timeframes. The role coordinates care and discharge planning with patients, families, healthcare teams, medical staff, hospital departments, ancillary services, community agencies, and external organizations. It supports safe and timely transitions, patient choice and satisfaction, and compliance with regulatory requirements.

The position performs concurrent and retrospective utilization reviews, documents discharge-planning and utilization-review activities, provides clinical updates to payers, coordinates denial activity, manages avoidable delays, and delivers applicable CMS regulatory notices within established timeframes. It also serves as a resource to medical and hospital staff on admission status, acute-care criteria, utilization management, care coordination, discharge planning, and regulatory requirements. The manager must provide care appropriate to the ages and developmental needs of the patients served.

This is a part-time, benefits-eligible position at Atrium Health Pineville, scheduled every Saturday and Sunday from 7:00 a.m. to 7:30 p.m., for 24 hours per week. The listed pay range is $38.20–$57.30.

Requirements

• Graduate of a Board of Nursing-approved nursing education program (RN).
• Current RN license or temporary license as a Registered Nurse Petitioner in the state where the employee works and resides, or meet applicable home-state licensure requirements when declaring a National License Compact state as the primary state of residency.
• Typically, three years of related nursing experience.
• Clinical experience within the assigned population.
• Extensive knowledge of disease processes and clinical outcomes.
• Ability to prioritize and organize work.
• Effective communication skills.
• Ability to use critical thinking and make timely decisions.
• Ability to navigate an Electronic Health Record.
• Basic ability to use MS Office products.
• Knowledge of Medicare A and B guidelines.
• Knowledge of Managed Care program requirements and implications.
• Ability to apply elements of Utilization Management programs.
• Ability to sit for approximately 50 percent of the workday and to stand and walk the equivalent of several blocks at a time.
• Ability to lift up to 10 lbs. continuously, 20 lbs. frequently, and 50 lbs. occasionally.
• Manual dexterity to operate a computer and calculator; visual acuity to review documents, computer screens, and medical records and record information accurately; and speech and hearing abilities for effective communication and telephone conversations.

Nice To Haves

• Bachelor of Science degree in Nursing (BSN).
• Case Management experience or background.
• Strong critical-thinking and analytical skills.
• Appropriate professional certification, preferred within three years of hire.

Responsibilities

• Conduct complete assessments, establish appropriate plans, and initiate interventions within desired timeframes.
• Collaborate and negotiate with patients, families, and care teams to support patient and organizational goals, care choices, satisfaction, discharge planning, and transitions.
• Involve patients and families in problem-solving and decision-making from admission throughout the hospital stay, using their strengths.
• Coordinate continuity of care and discharge planning in accordance with regulatory standards, including communication for smooth patient transfers.
• Provide case-management services addressing healthcare levels, finances, housing, family discord, and illness adjustment within department scope; use community resources and educate patients and families about services.
• Initiate internal and external referrals to support timely care progression and transitions.
• Document discharge-planning interventions and utilization-review activity according to department and medical-center standards.
• Perform and document accurate, timely concurrent and retrospective reviews using approved criteria.
• Communicate effectively with the healthcare team and partner with Social Work and unlicensed support personnel to establish and implement safe care plans.
• Participate in the MDR and work with medical staff, hospital departments, and ancillary services to identify and resolve discharge barriers, avoid care delays, and implement and report care coordination, discharge-planning, and utilization-management activities.
• Collaborate with managers, physicians, medical directors, advisory groups, and treatment teams on physician practices and patient-care best practices.
• Refer cases to a physician advisor when needed to support care progression, accurate status, and regulatory compliance.
• Maintain knowledge of healthcare regulations, reimbursement issues, length-of-stay impacts, and community resources.
• Complete utilization-management activities according to local structure, including payer and external-review clinical updates, data collection, denial coordination, utilization-management support, and management of avoidable delays.
• Deliver CMS regulatory notices within established timeframes, as applicable to site guidelines.
• Build productive relationships with community agencies and networks and collaborate internally and externally to meet patient and family needs.
• Collaborate with Advocate Ambulatory Care Management and Continuing Health toward shared goals and outcomes.
• Educate and serve as an expert resource to medical and hospital staff on admission status, acute-care criteria, utilization management, care coordination, discharge planning, and regulatory requirements.
• Demonstrate the knowledge and skills needed to assess and provide care appropriate to patients’ ages and developmental needs.
• Perform other related duties as required.

Benefits

• Comprehensive benefits and well-being programs.
• Paid Time Off programs.
• Medical, dental, vision, life, and short- and long-term disability benefits.
• Flexible Spending Accounts for eligible healthcare and dependent-care expenses.
• Adoption assistance and paid parental leave.
• Defined-contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.
• Potential premium pay, incentive pay for select positions, and annual increases based on performance.

What This Job Offers

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