Registered Nurse (RN) - Hospital Care Manager, Hospital Care Management, PRN, Days

Prisma Health•Maryville, TN

5d•Onsite

About The Position

This role serves as an integral care team partner focused on patient engagement and activation. The primary accountability is for patients' care transitions out of the acute care setting, positively impacting longitudinal care plan alignment. In collaboration with physicians, this position leads the multidisciplinary team, including clinical staff and payors, to ensure efficient delivery of quality, cost-effective care. The role leads the team for each patient individually with the goal to maximize autonomy where possible.

Requirements

Bachelor's degree in Nursing
Licensed to practice as a Registered Nurse in South Carolina

Nice To Haves

One (1) year acute care case management experience preferred.
Accredited Case Manager (ACM) or Certified Case Manager (CCM) is preferred.
Knowledge of Medical Necessity Criteria is preferred.

Responsibilities

Partners with attending providers throughout hospitalization to promote effective and efficient utilization of clinical resources, ensuring quality, cost-effective care.
Anticipates next steps and facilitates communication to maximize care efficiencies for the patient and family.
Identifies social determinants of health that increase the patient's risk for negative outcomes.
Ensures clear documentation for the interdisciplinary care team and coordinates post-acute plans with the ambulatory care management team as appropriate.
Facilitates patient access to resources and relevant services.
Addresses and resolves system problems impeding diagnostic or treatment progress.
Proactively identifies, resolves, and documents delays and obstacles on the patient's behalf.
Drives change by identifying areas where performance improvement is needed.
Navigates value-based care with expertise and ensures longitudinal plan is patient-focused and aligns with patient and caregiver goals.
Assesses patients’ and family’s psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness, and ability to cope.
Maintains expert-level knowledge of body systems and expected clinical outcomes for patient disease process.
Maintains current knowledge of changes in state and federal regulatory requirements related to the provision of care management services in an acute care setting.
Maintains care management knowledge to provide services in accordance with standards of practice as established by department and management.
Ensures medical necessity, appropriate level of care, and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan.
Navigates the team through complex compliance, regulatory, and insurance requirements.
Coordinates with third-party payors on a regular basis.
Serves as a resource for patients and families with regard to their rights and responsibilities, when payment of care is denied or when care is no longer medically necessary.
Includes, but not limited to, delivery of the regulatory documents as provided by CMS.
Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system.
Performs other duties as assigned.