RN Care Manager - Case Management

Vitruvian Health•Cleveland, TN

1d•Onsite

About The Position

Vitruvian Health is seeking an RN Care Manager to join their Case Management team. This role practices with minimum supervision and is responsible for various components of case management, including assessment, facilitation, planning, advocacy, monitoring, evaluation, and outcomes. The position also involves coordinating communication between healthcare professionals, patients, and families to improve patient care quality and reduce service costs. The RN Care Manager must understand financial implications of care, including payer requirements, alternative care options, cost containment, and healthcare plans. Responsibilities include collaborating with the Utilization Review Team for admissions, monitoring observation stays, screening patients against criteria, and working with the Physician Advisor on cases that don't meet criteria. Discharge planning services, such as referrals for Home Health, DME, SNF, and IPR, are also a key part of the role. The case manager will identify performance improvement opportunities, assist with data collection, and contribute to program development and implementation for patient care initiatives. The average daily patient load is 20-25.

Requirements

Graduate of an accredited School of Nursing.
Current RN Nursing license in the State of Tennessee.
AHA BLS CPR required.

Nice To Haves

Certification in Case Management is desired.

Responsibilities

Assessment, facilitation, planning, advocacy, monitoring, evaluation, and outcomes of case management.
Facilitate communication and coordinate between all members of the healthcare team, involving the patient and family in the decision-making process.
Minimize fragmentation of the healthcare delivery system.
Effect change to improve the quality of patient care and reduce the cost of services.
Understand financial implications of care, including requirements for prior approval by payer, alternative care options, cost containment, and healthcare plans.
Collaborate with the Utilization Review Team to assist with the admission process for non-elective, emergency inpatient admissions and outpatient observation stays.
Monitor observation stays at the end of 23 hours for possible inpatient admission or discharge planning.
Ensure all patients are screened against Interqua/Milliman or other appropriate criteria and assist the physician in identifying alternative methods of care when criteria are not met.
Work closely with the Physician Advisor on cases that do not meet admission criteria or continued stay criteria.
Provide discharge planning services, such as Home Health, DME, SNF and IPR referrals to facilitate a timely discharge plan.
Collaborate as a team to ensure timely provision of services.
Identify performance improvement opportunities and assist with data collection.
Assist in program development and implementation for specific programs and plans of patient care such as clinical pathway, population specific and disease management initiatives.
Coordinate the care of an average care load of 20-25 patients per day.