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

Prisma Health • Greenville, SC

101d

About The Position

The Hospital Case Manager (HCM) provides case management service for hospital patients, including, but not limited to, 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, leads the multidisciplinary team including clinical staff and payors to ensure efficient delivery of quality, cost-effective care.

Requirements

• Bachelor's degree in Nursing.
• Three (3) years acute care nursing experience.
• One (1) year acute care case management experience preferred.
• Licensed to practice as a Registered Nurse in South Carolina.
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) is preferred.

Nice To Haves

• Knowledge of Medical Necessity Criteria is preferred.

Responsibilities

• Partners with the attending providers throughout hospitalization to promote effective and efficient utilization of clinical resources, ensuring quality, cost effective care.
• Anticipate next steps and facilitate 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.
• On the basis of preliminary risk screening, 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.
• 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.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees