Inpatient RN Care Manager

American Addiction Centers • Skaneateles, NY

1d • Onsite

About The Position

The Inpatient RN Care Manager is responsible for conducting complete assessments, establishing appropriate plans, and initiating interventions within desired timeframes. This role involves effective collaboration and negotiation with patients, families, and healthcare teams to achieve patient and organizational goals related to care needs, choices, and satisfaction during discharge planning and care transitions. The Care Manager utilizes patient/family strengths in problem-solving, involving them in the decision-making process from admission throughout the hospital stay. They provide continuity of care and discharge planning services compliant with regulatory standards, offering coordinated options and services based on assessed needs to ensure patients, families, and the healthcare team are informed and can proceed with accountabilities in a timely manner. This includes facilitating smooth transitions for patients, families, and staff during patient transfers. The role also encompasses providing case management services for various healthcare, financial, housing, family discord, or illness adjustment issues, managing family dynamics and crisis situations professionally, utilizing community resources effectively, and educating patients/families on accessing and using services. Initiating internal and external referrals to ensure timely progression of care and transitions is also a key responsibility. The position requires timely documentation of discharge planning interventions and utilization review activity per department and medical center standards, as well as performing and documenting accurate concurrent and retrospective reviews based on approved established criteria. Effective communication with the healthcare team, partnership with Social Work and unlicensed support personnel for safe care plans, and active participation in the Outcome Facilitation Team/Patient Care Multidisciplinary Team are essential. The Care Manager works closely with medical staff, hospital departments, and ancillary services to identify and resolve barriers to discharge, expedite care delivery, and implement/report care coordination, discharge planning, and utilization management (UM) activities. Collaboration with managers, physicians, medical directors, advisory groups, and treatment teams on physician practices and best care plan practices is expected. Referring cases to a physician advisor as needed for efficient care progression, accurate status, and regulatory compliance is also part of the role. The incumbent must remain knowledgeable in healthcare regulations, reimbursement issues, length of stay impacts, and community resources. Completing UM activities, including providing clinical updates to payers, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays, is required. Delivering CMS regulatory notices within established timeframes and developing/maintaining productive relationships with community-based agencies and networks are also key functions. Collaboration with Advocate Aurora Ambulatory Care Management and Continuing Health to meet common goals and outcomes is expected. The Care Manager serves as an educator and expert resource to medical and hospital staff regarding admission status, acute care criteria, UM issues, care coordination, discharge planning needs, and relevant regulatory requirements. The role requires the ability to demonstrate knowledge and skills for age-appropriate patient care, understanding growth and development principles, assessing patient status, and interpreting information to meet age-specific needs.

Requirements

• Registered Nurse License issued by the state in which the Team Member practices.
• Bachelor’s Degree in Nursing
• 2 years of clinical nursing experience.
• 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.

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.
• Facilitates 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.
• Manages 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 Outcome Facilitation Team/Patient Care Multidisciplinary Team 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 Aurora Health Care in a positive manner working collaboratively, internally, and externally, to meet patient/family needs.
• Works in collaboration with Advocate Aurora 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.
• Demonstrates knowledge and skills necessary to provide care appropriate to the age of the patients served.
• Demonstrates knowledge of the principles of growth and development over the life span and possesses 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

• Competitive compensation
• Generous retirement offerings
• Programs that invest in your career development
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level