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

Prisma Health • Greenville, SC

90d

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

• Bachelors degree in nursing, preferred
• Three (3) years acute care nursing experience.
• One (1) year acute case management experience preferred.
• South Carolina RN license

Responsibilities

• Participates in discharge planning activities for patients with complex medical issues, in order to ensure a timely discharge and to provide appropriate linkage with post-acute care providers.
• Consults with interdisciplinary team, Physician Advisor and administrative leadership as necessary to resolve barriers regarding progression of care.
• Addresses and resolves system problems impeding diagnostic or treatment progress.
• Proactively identifies and resolves delays and obstacles during the hospital discharge planning process.
• Monitors the patient progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
• 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.
• 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 process.
• 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.
• Uses established clinical guidelines for initial/admission and continued stay reviews for patients within assigned unit to ensure medical necessity, appropriate level of care and timely implementation of plan of care in accordance with 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.
• Responds to requests for additional information within 24 hrs or next business day.
• Ensures that patient goals are set with patient/family, negotiates healthcare resources and educates patient/family regarding options of care throughout the continuum.
• Monitors patient's progress and intervenes as necessary to ensure delivery of quality, efficient, cost-effective services.
• 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.

What This Job Offers

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