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

Prisma Health•Greenville, SC

1d•Onsite

About The Position

The Hospital Care Manager is an integral care team partner focused on patient engagement and activation, with primary accountability for patients’ transitions out of the acute care setting and alignment of longitudinal care plans. In collaboration with physicians, the role leads a multidisciplinary team—including clinical staff and payors—to support efficient delivery of quality, cost-effective care and maximize each patient’s autonomy where possible. The position partners with attending providers throughout hospitalization, coordinates communication and post-acute plans, identifies social and psychosocial risks, facilitates access to resources, and addresses barriers or delays in diagnostic and treatment progress. It also supports patient- and caregiver-focused, value-based care planning; ensures medical necessity, appropriate level of care, and timely implementation of care plans; and navigates regulatory, compliance, and insurance requirements. The role provides patients and families with information about their rights and responsibilities, including when payment is denied or care is no longer medically necessary, and advocates for their empowerment and independence in healthcare decisions. This is a non-management position reporting to a supervisor, manager, director, or executive. The work shift is variable at Greenville Memorial Hospital in Greenville, South Carolina.

Requirements

Bachelor’s degree in Nursing; a nursing diploma or Associate degree in Nursing may be considered under the stated BSN Memorandum of Understanding (MOU) pathway.
Three years of acute care nursing experience.
Current RN compact/multistate license recognized by the NCSBN Compact State, or a license to practice as an RN in the state where the team member works.
Applicants using the diploma or associate-degree pathway must agree to enroll in an accredited BSN or MSN program within one year and obtain a BSN or MSN degree within four years of hire; sufficient annual progress is required to remain eligible for employment.
Employees in this title before 10/24/2021 are grandfathered and are only required to have an ADN or nursing diploma.

Nice To Haves

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

Responsibilities

Partner with attending providers throughout hospitalization to promote effective, efficient use of clinical resources and quality, cost-effective care.
Anticipate next steps and facilitate communication to improve care efficiencies for patients and families.
Identify social determinants of health and psychosocial risk factors that may increase the risk of negative outcomes.
Document clearly for the interdisciplinary care team and coordinate post-acute plans with ambulatory care management as appropriate.
Facilitate patient access to resources and relevant services.
Address system problems that impede diagnostic or treatment progress; proactively identify, resolve, and document delays and obstacles.
Identify opportunities for performance improvement and drive change.
Ensure longitudinal plans are patient-focused and aligned with patient and caregiver goals while navigating value-based care.
Maintain knowledge of body systems, expected clinical outcomes, regulatory requirements, and care management standards of practice.
Ensure medical necessity, appropriate level of care, and timely implementation of care plans in accordance with the hospital Utilization Review Plan.
Guide the team through compliance, regulatory, and insurance requirements, and coordinate regularly with third-party payors.
Serve as a resource for patients and families regarding their rights and responsibilities, payment denials, and care that is no longer medically necessary, including delivery of applicable CMS regulatory documents.
Advocate for patient and family empowerment, independence, autonomous healthcare decisions, and access to needed services.
Perform other duties as assigned.