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

Prisma Health•Greenville, SC

3d•Onsite

About The Position

The Hospital Care Manager is an integral care team partner focused on patient engagement and activation, accountable for transitions out of acute care, and responsible for supporting alignment with patients’ longitudinal care plans. In collaboration with physicians, the role leads a multidisciplinary team—including clinical staff and payors—to support efficient, quality, cost-effective care and maximize each patient’s autonomy where possible. The position is PRN, works variable shifts, and is based at Greenville Memorial Hospital. The care manager partners with attending providers throughout hospitalization, coordinates with patients, families, and care teams, supports safe transitions and access to services, and helps resolve barriers to diagnosis and treatment. The role also supports utilization review, regulatory and insurance compliance, and patient and family understanding of rights, responsibilities, and care decisions.

Requirements

Bachelor’s degree in Nursing, subject to the stated in-lieu-of provisions.
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.
If qualifying in lieu of the BSN requirement with a nursing diploma or Associate degree in Nursing, 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; demonstrate sufficient annual progress toward the degree to remain eligible for employment.
Employees in this title before 10/24/2021 are grandfathered and require only 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 during hospitalization to support effective, efficient use of clinical resources and quality, cost-effective care.
Anticipate care needs and facilitate communication to improve care efficiency for patients and families.
Identify social determinants of health that may increase risk of negative outcomes; document relevant information for the interdisciplinary team and coordinate post-acute plans with ambulatory care management as appropriate.
Facilitate patient access to resources and relevant services.
Identify, resolve, and document system problems, delays, and obstacles affecting diagnostic or treatment progress; identify opportunities for performance improvement.
Guide value-based care and help ensure longitudinal plans are patient-focused and aligned with patient and caregiver goals.
Assess patients’ and families’ psychosocial risk factors, including prior functioning, support systems, reactions to illness, and ability to cope.
Maintain knowledge of body systems, expected clinical outcomes, and applicable state and federal regulatory requirements and care management 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 and coordinate regularly with third-party payors.
Help patients and families understand their rights and responsibilities when payment is denied or care is no longer medically necessary, including delivery of applicable CMS regulatory documents.
Advocate for patient and family empowerment, autonomous healthcare decisions, and access to needed services.
Perform other duties as assigned.