Registered Nurse (RN) - Case Manager PRN

Lifepoint Health•Hickory, NC

1d•Onsite

About The Position

Frye Regional Medical Center is seeking a Registered Nurse (RN) to join their team as a Clinical Case Manager. This PRN position involves a Monday-Friday schedule. As part of Lifepoint Health, the role is dedicated to making communities healthier by providing exceptional care. The Case Manager is accountable for the execution, adaptation, and outcome of care management, ensuring resource utilization, appropriateness of care, and adherence to a designated Geometric Length of Stay (GLOS) for each patient.

Requirements

Current state RN license.
Basic Life Support certification is required within 30 days of hire.
Minium work experience 1-3 years Case Management experience preferred.

Nice To Haves

Bachelor’s degree preferred but not required
ACMA Certificate highly preferred
CCM Certification highly preferred

Responsibilities

Assists in developing departmental goals, standards, and objectives aligned with the organization's strategic plan and vision.
Creates and fosters an environment that encourages professional growth.
Integrates evidence-based practices into operations and clinical protocols.
Assesses the quality of patient care delivered and coordinates services with patients, staff, physicians, and other departments.
Works with interdisciplinary teams to facilitate decision-making aligned with care plans and patient/family wishes.
Coordinates care and services within the case-managed population.
Understands payer issues and anticipates opportunities to reduce expenses and capture revenue from admission through discharge.
Educates physicians and staff on Case Management standards and regulatory requirements (Joint Commission, OSHA, CMS, HCFA, AHCA).
Mentors staff on Utilization Review (UR) standards and Length of Stay (LOS) topics.
Performs patient/family assessments on admission to identify individualized care management needs.
Collaborates with nursing staff to plan strategies for care needs requiring nursing expertise.
Coordinates care plans and services to integrate patients into the healthcare continuum.
Develops, reviews, and revises care pathways for specific DRGs to meet regulatory requirements and reduce LOS and readmissions.
Ensures timely and accurate documentation of care plans and Case Management interventions.
Advocates for patients and families throughout the care episode.
Participates in Interdisciplinary Team Meetings.
Maintains effective communication with all disciplines.
Provides feedback to the healthcare team regarding patient progress and barriers to care.
Coordinates changes to the care plan as needed.
Performs admission and concurrent medical record reviews.
Documents utilization review per departmental guidelines.
Facilitates physician documentation to reflect patient condition, comorbidities, and procedures.
Educates patients/families on third-party payer guidelines and discharge financial implications.
Manages denial appeals and chart audit reviews.
Acts as gatekeeper for hospital admissions by initiating care in the ED.
Encourages use of reimbursable diagnoses and interfaces with community agencies.
Creates care plans for high-utilization patients and redirects to appropriate hospital services.
Monitors and manages resource use to prevent extended LOS.
Observes ED processes and ensures appropriate level-of-care placement.
Uses EMR and MCG Criteria for utilization management and quality screening.
Identifies and resolves delays in care and discharge planning.
Consults with appropriate departments to expedite care.
Applies conflict resolution skills to ensure timely issue resolution.
Applies utilization acuity criteria and documents findings.
Identifies at-risk populations and follows reporting procedures.
Refers cases to Physician Advisor or secondary reviewer and follows up as needed.
Discusses payer criteria with clinical staff.
Manages discharge planning in coordination with Social Workers.
Initiates referrals for home health, hospice, medical equipment, and facility transfers.
Accurately performs patient assessments and identifies patient needs.
Identifies and initiates appropriate nursing interventions.
Provides care appropriate to condition and age of the patient.
Performs timely and appropriate documentation relating to medical necessity in the medical record.
Responsible for completion and revision of the Interdisciplinary Care Plan for each patient.
Performs timely and accurate QI assessments.