Registered Nurse (RN) -Hospital Case Manager, PRN, Days

Prisma Health•Columbia, SC

5d•Onsite

About The Position

The Hospital Case Manager (HCM) provides case management services for hospital patients, focusing on utilization management to ensure efficient, cost-effective patient progression through the continuum of care and discharge to an appropriate level of care. In collaboration with physicians, the HCM leads a multidisciplinary team, including clinical staff and payors, to ensure efficient delivery of quality, cost-effective care.

Requirements

Bachelors degree in nursing
Three (3) years acute care nursing experience.
South Carolina RN license

Nice To Haves

One (1) year acute case management experience preferred.

Responsibilities

Participates in discharge planning activities for patients with complex medical issues to ensure timely discharge and appropriate linkage with post-acute care providers.
Consults with the interdisciplinary team, Physician Advisor, and administrative leadership to resolve barriers regarding progression of care.
Collaborates with physicians throughout hospitalization, developing effective working relationships and providing expertise regarding payor and regulatory guidelines.
Addresses and resolves system problems impeding diagnostic or treatment progress.
Proactively identifies and resolves delays and obstacles during the hospital discharge planning process.
Monitors patient progress, intervening as necessary and appropriate to ensure the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective.
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, based on preliminary risk screening.
Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system.
Maintains expert-level knowledge of body systems and expected clinical outcomes for patient disease processes.
Maintains current knowledge of changes in state and federal regulatory requirements related to the provision of case management services in a tertiary acute care setting.
Maintains case management knowledge to provide services in accordance with standards of practice as established by department and management.
Uses established clinical guidelines for initial/admission and continued stay reviews for patients within assigned units to ensure medical necessity, appropriate level of care, and timely implementation of the plan of care in accordance with the hospital's Utilization Review Plan.
Promotes effective and efficient utilization of clinical resources, ensuring quality, cost-effective care.
Provides timely clinical reviews to third-party payors and responds to requests for additional information within 24 hours or the next business day.
Ensures that patient goals are set with the patient/family, negotiates healthcare resources, and educates the patient/family regarding options of care throughout the continuum.
Serves as a resource for patients and families regarding their rights and responsibilities when payment of care is denied or when care is no longer medically necessary, including delivery of regulatory documents as provided by CMS.