PWMC Case Manager (PRN)

Phoebe Putney Health System•Fort Worth, TX

10d

About The Position

The Nurse Case Manager coordinates patient care from entry through discharge for patients receiving inpatient and observation services at PPHS facilities. The role addresses appropriate and timely admission, discharge, and care; conducts first-level clinical reviews using hospital-approved criteria and the Care Management Program’s Utilization Plan and payer requirements; and supports efficient, effective care at the appropriate level. The Care Manager works with social work, physicians, nurses, and the interdisciplinary team to provide quality, timely, and cost-effective case management, address readmission issues, and facilitate patient progression through a defined plan of care toward optimal outcomes. Under the direction of the Care Management Team Lead and Director of Care Management, the Care Manager develops, facilitates, and implements case management and discharge plans in coordination with nursing, social work, physicians, and other team members. The position performs utilization review, discharge and transition planning, patient and family education, care assessments, referrals, documentation, and quality-improvement activities. It also supports compliance with applicable regulations and payer requirements, patient rights, and timely care.

Requirements

Associate's Degree in Nursing from a state-accredited school.
At least 3 years of recent acute-care experience with relevant clinical experience in the assigned area.
Current Registered Nurse (RN) license in Georgia.
Knowledge of current federal, state, and accreditation requirements applicable to utilization review and discharge planning.
Ability to perform care-management assessments, utilization reviews, coordination, discharge planning, and accurate electronic documentation.

Nice To Haves

Bachelor's Degree from a state-accredited School of Professional Nursing.
At least 1 year of Case Management or Utilization Review experience in a hospital or related setting.
Certified Case Manager (CCM).

Responsibilities

Coordinate patient care from point of entry through discharge for inpatient and observation patients.
Perform prospective, concurrent, and, when required, retrospective utilization reviews using established clinical criteria and payer requirements.
Plan and facilitate discharge and transitions of care, including developing appropriate plans of care and intervening to address complex discharge issues.
Coordinate care with social workers, physicians, nurses, and other interdisciplinary team members to support safe, timely, and effective patient progression.
Educate physicians, nurses, hospital personnel, patients, and families about care management processes, payer or regulatory requirements, discharge services, and care options.
Assess patient and family clinical, emotional, cultural, psychosocial, and financial needs; identify risks and make timely referrals to appropriate disciplines, agencies, or community resources.
Identify actual or potential delays in care and work with relevant teams to promote timely services and prevent quality, medical-necessity, authorization, or payment issues.
Document reviews, referrals, transition-planning activities, follow-up, outcomes, and other pertinent information accurately and promptly in the appropriate electronic system.
Assess readmission patterns, trends, and contributing factors, and collaborate with the care team to prevent future readmissions.
Participate in quality-improvement activities, projects, committees, staff education, and professional development related to care management.
Follow hospital and departmental policies, attendance and punctuality guidelines, mandatory training, competency requirements, and applicable patient-care expectations.