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

Prisma Health•Greenville, SC

1d•Onsite

About The Position

The Registered Nurse Hospital Care Manager is an integral care-team partner focused on patient engagement and activation. The role is primarily accountable for patients’ transitions out of the acute care setting and for aligning longitudinal care plans with patient and caregiver goals. In collaboration with physicians, the nurse leads a multidisciplinary team—including clinical staff and payors—to deliver quality, cost-effective care and maximize each patient’s autonomy where possible. The role partners with attending providers throughout hospitalization to promote effective use of clinical resources, support communication, coordinate post-acute plans, and address obstacles to diagnostic or treatment progress. It also assesses psychosocial risks, connects patients and families with resources, and helps ensure care is medically necessary, at the appropriate level, and implemented in a timely manner. The position navigates regulatory, compliance, and insurance requirements and supports patients and families in understanding their rights and making autonomous healthcare decisions.

Requirements

Bachelor’s degree in Nursing.
Three years of acute-care nursing experience.
Current RN compact/multistate license recognized by the NCSBN Compact State, or an RN license to practice in the state where the team member works.
If substituting a nursing diploma or Associate degree in Nursing for the BSN, sign a BSN Memorandum of Understanding agreeing to enroll in an accredited BSN or MSN program within one year and obtain a BSN or MSN within four years of hire. Sufficient annual progress toward the degree is required to remain eligible for employment.
Employees in this title before 10/24/2021 are grandfathered and require only an Associate degree in Nursing 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 efficiency for patients and families.
Identify social determinants of health that increase the risk of negative patient 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 and resolve system problems that impede diagnostic or treatment progress.
Proactively identify, resolve, and document delays and obstacles on the patient’s behalf.
Identify areas requiring performance improvement and help drive change.
Align longitudinal care plans with patient and caregiver goals while navigating value-based care.
Assess patients’ and families’ psychosocial risk factors, including prior functioning, support systems, reactions to illness, and ability to cope.
Maintain knowledge of body systems and expected clinical outcomes for the patient’s disease process.
Stay current on state and federal regulatory requirements related to acute-care management services and follow department standards of practice.
Ensure medical necessity, appropriate level of care, and timely implementation of the plan of care in accordance with the hospital Utilization Review Plan.
Guide the team through compliance, regulatory, and insurance requirements; coordinate regularly with third-party payors.
Inform and support patients and families regarding their rights and responsibilities when payment is denied or care is no longer medically necessary, including delivery of applicable CMS documents.
Advocate for patient and family empowerment, independence, autonomous healthcare decisions, and access to needed services.
Perform other duties as assigned.