Inpatient Care Manager NEX

Advocate Health•Charlotte, NC

7d•$38 - $57•Onsite

About The Position

The Inpatient Care Manager is responsible for conducting complete assessments, establishing appropriate plans, and initiating interventions within desired timeframes. This role collaborates and negotiates effectively with patients, families, and the healthcare team to achieve patient and organizational goals related to care needs, choices, and satisfaction during discharge planning and care transitions. The position involves utilizing patient/family strengths in problem-solving, involving them in decision-making from admission throughout the hospital stay. The Care Manager provides continuity of care and discharge planning services compliant with regulatory standards, ensuring coordinated options and services based on assessed needs. This includes facilitating smooth transitions for patients, families, and staff during transfers. The role also involves providing case management services for various healthcare, financial, housing, family discord, or adjustment issues, managing family dynamics and crisis situations, using community resources effectively, and educating patients/families on accessing and using services. Initiating internal and external referrals, documenting interventions, and performing utilization reviews are key responsibilities. The Inpatient Care Manager communicates effectively with the healthcare team, partners with Social Work and unlicensed support personnel, and actively participates in the MDR to resolve discharge barriers and expedite care delivery. Collaboration with managers, physicians, and treatment teams on best practices and referring cases to physician advisors as needed are also part of the role. Staying knowledgeable about healthcare regulations, reimbursement, length of stay impacts, and community resources is essential. The position requires delivering CMS regulatory notices within established timeframes and developing productive relationships with community agencies. The Care Manager serves as an educator and expert resource to medical and hospital staff on various utilization management and discharge planning topics. The role requires demonstrating knowledge and skills appropriate for the age of the patients served, including understanding growth and development across the lifespan and assessing patient status based on age-specific needs.

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 in which you work and reside or if declaring a National License Compact (NLC) state as your primary state of residency, meet the licensure requirements in your home state; or for Non-National License Compact states, (where applicable) current RN license or temporary license as a Registered Nurse
Typically requires 3 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.
Utilization of critical thinking and timely decision making.
Ability to navigate the Electronic Health Record.
Basic utilization of MS Office products.
Knowledge of Medicare A and B guidelines.
Knowledge of Managed Care program requirements/implications.
Ability to apply elements of Utilization Management programs.
Must be able to sit up to approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally.
Manual dexterity required for operation computer and calculator.
Visual acuity required for facilitating review of written documents/computer screens, medical records, and to record information accurately.
Clear verbal communications and hearing acuity required for receiving instructions and converse on standard telephone.
Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.
Operates all equipment necessary to perform the job.

Nice To Haves

Preferred Bachelor of Science degree in Nursing (BSN).
Case Management experience or background preferred.
Strong critical thinking and analytical skills preferred.
Appropriate Professional certification preferred within 3 years of hire

Responsibilities

Conducts complete assessments, establishes appropriate plans, and initiates interventions within desired timeframes.
Collaborates and negotiates effectively with patient, family, and team while striving to achieve patient and organizational goals with regard to patient’s care needs, choice and satisfaction when discharge planning/transitioning care.
Utilizes patient/family strengths in the problem-solving process, involving the patient/family and team in the decision-making process beginning on admission and continuing throughout patient’s hospital stay.
Provides continuity of care and discharge planning services compliant with regulatory standards by providing coordinated relevant options and services based on assessed needs to ensure patient/family and healthcare team is informed and able to proceed with accountabilities in a timely manner.
This includes participating in the communication process to facilitate a smooth transition for patient, family, and staff when patients are transferred.
Provides case management services related to various levels of health care, finances, housing, family discord, or illness adjustment, based department scope.
This may include managing family dynamics and crisis situations in a timely and professional manner, using community resources effectively, and educating patient/family regarding access to and use of services.
Initiates internal and external referrals to assure timely progression of care and transitions.
Documents discharge planning interventions and utilization review activity per department and medical center standards in a timely manner.
Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria as required by department standards.
Communicates effectively with the healthcare team.
Works in partnership with Social Work and unlicensed support personnel to effectively establish and implement a safe plan of care.
Serves as an active member of the MDR and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities.
Collaborates with managers, physicians, medical directors, advisory groups, and treatment teams for issues related to physician practices and best practices for the patient’s plan of care.
Refers cases to physician advisor as needed to ensure efficient progression of care, accurate status, and compliance with regulatory guidelines.
Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on length of stay and community resources.
Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.
Delivers CMS regulatory notices within CMS established timeframes, as appropriate based on-site guidelines.
Develops and maintains productive relationships with community-based agencies and networks by representing Advocate Health Care in a positive manner working collaboratively, internally, and externally, to meet patient/family needs.
Works in collaboration with Advocate Ambulatory Care Management and Continuing Health to meet common goals and outcomes.
Serves as an educator and expert resource to medical and hospital staff regarding admission status and acute care criteria, utilization management issues, care coordination and discharge planning needs, and relevant regulatory requirements.
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served.
Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures.

Benefits

Comprehensive suite of Total Rewards: benefits and well-being programs
Competitive compensation
Generous retirement offerings
Programs that invest in your career development
Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program