Inpatient Care Manager

Advocate Health•Winston-Salem, NC

1d•$38 - $57

About The Position

The Inpatient Care Manager conducts patient assessments, develops plans, and initiates interventions to support care needs, patient choice, and satisfaction during discharge planning and transitions. The role involves partnering with patients, families, and the healthcare team throughout the hospital stay, using patient and family strengths in problem-solving and shared decisions. The manager coordinates continuity of care and discharge planning in accordance with regulatory standards. This includes identifying services and options based on assessed needs, coordinating transfers, initiating referrals, documenting discharge planning and utilization review activity, and completing concurrent and retrospective reviews. The role also supports case management needs involving healthcare, finances, housing, family dynamics, or adjustment to illness, and educates patients and families about accessing community resources and services. Working with Social Work, medical staff, hospital departments, ancillary services, managers, physicians, and treatment teams, the Inpatient Care Manager helps resolve barriers to discharge and avoid delays in care. The position participates in multidisciplinary rounds, supports utilization management, communicates clinical updates to payers or external review organizations, coordinates denial activity, manages avoidable delays, and delivers CMS regulatory notices within required timeframes. The manager also serves as an educator and resource on admission status, acute care criteria, utilization management, care coordination, discharge planning, and regulatory requirements. The position requires knowledge and skills to provide age-appropriate care across the lifespan, including assessing patient status and identifying age-specific needs. The role is based in a normal office environment and requires use of a computer, calculator, and other equipment needed to perform the job.

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; alternatively, meet applicable licensure requirements if declaring an NLC state as the primary state of residency, or hold a current or temporary RN license in a non-NLC state where applicable.
Typically requires 3 years of related nursing experience.
Clinical experience within the assigned patient 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 the 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 meet the physical and communication requirements of the role, including sitting, standing, walking, lifting, manual dexterity, visual acuity, and telephone communication.

Nice To Haves

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

Responsibilities

Conduct complete assessments, establish plans, and initiate interventions within appropriate timeframes.
Collaborate and negotiate with patients, families, and the healthcare team to support care needs, choice, satisfaction, and organizational goals during discharge planning and care transitions.
Involve patients, families, and the team in decision-making from admission throughout the hospital stay, using patient and family strengths in problem-solving.
Coordinate continuity of care and discharge planning in compliance with regulatory standards, including transfers and timely communication of relevant options, services, and accountabilities.
Provide case management services related to healthcare, finances, housing, family discord, and illness adjustment, within the department's scope.
Manage family dynamics and crisis situations professionally, use community resources, and educate patients and families about access to and use of 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 established 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 multidisciplinary rounds and work with medical staff, hospital departments, and ancillary services to identify and resolve discharge barriers, prevent 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 best practices for patient care plans.
Refer cases to a physician advisor as needed to support efficient care progression, accurate patient status, and regulatory compliance.
Maintain knowledge of healthcare regulations, reimbursement, length-of-stay impacts, and community resources.
Complete utilization management activities, including providing clinical updates to payers or external review organizations, collecting data, coordinating denial activity, supporting UM, and managing avoidable delays.
Deliver CMS regulatory notices within established timeframes, as appropriate to site guidelines.
Develop productive relationships with community agencies and networks, representing Advocate Health Care positively and collaborating internally and externally to meet patient and family needs.
Collaborate with Advocate Ambulatory Care Management and Continuing Health to meet 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 knowledge and skills necessary to provide age-appropriate care and assess and interpret patient information to identify age-specific needs in accordance with departmental policies and procedures.