REGISTERED NURSE CASE MANAGER - (IN-PATIENT)

Conway Medical Center•Conway, SC

About The Position

The Registered Nurse Case Manager (RN-CM) works primarily in one of three focus areas: Bed Control, Utilization Review, or Discharge Planning. Although the RN-CM may be assigned to a focused area, the role may shift among these areas as departmental needs require. The position coordinates patient care and services across a continuum of care. The RN-CM completes other duties as assigned by department leadership.

Requirements

Associate degree (AS) in Nursing.
At least two years of current nursing-practice experience.
Current Registered Nurse licensure in good standing in the State of South Carolina (SCLLR).

Nice To Haves

Bachelor’s degree (BS) in Nursing.
Previous experience with reimbursement and pre-certification practice.
Previous experience as an RN case manager in an acute care setting.

Responsibilities

Coordinate emergency and direct admissions with physicians and nurses based on bed availability, treatment plans, and admission criteria.
Maintain communication with the Emergency Department, Operating Room, and specialty areas; attend daily care coordination rounds and recommend appropriate patient placement and timing.
Collect, analyze, evaluate, and summarize information about bed utilization from referring hospitals, physicians, and clinics; assess scheduled admissions, available beds, and patient transfer requests.
Coordinate with case managers to ensure compliance with standards for pending discharges for the current and following day.
Collect, investigate, and share clinical, diagnosis, treatment-plan, and insurance information with Patient Access Service personnel for admission-criteria evaluation.
Perform and coordinate initial and ongoing patient-status assessments, document case information in a database, and conduct chart reviews or audits monthly or as needed.
Review and audit patient treatment files to support quality, cost-efficient, compliant care and help prevent unnecessary procedures, ineffective treatment, or unnecessarily prolonged hospital stays.
Review precertification requests for medical necessity; initiate elective precertification and coordinate urgent or emergent admission authorization.
Coordinate out-of-network admissions, admissions lacking a primary care provider referral, uninsured admissions, and other special admissions with attending physicians and others.
Refer long-term diagnoses, stays exceeding five days, and other high-risk diagnoses to case management to support appropriate clinical pathways.
Participate in monthly case conferences and provide information relevant to patient needs and goals; partner with the Program Director to develop and review individualized coordination-of-care plans.
Ensure patient medical needs are addressed; consult with physicians, coordinate treatment plans, and advocate for patients when needed.
Help patients access entitlements, resources, information, and referrals for psychosocial needs; empower patients to participate in care-planning decisions.
Maintain accurate, timely, readily accessible patient information and assist with data collection for reporting and funding sources.
Complete other duties assigned by department leadership.