RN Care Manager Registry

American Addiction Centers

1d•Onsite

About The Position

The RN Care Manager Registry is responsible for conducting complete assessments, establishing appropriate plans, and initiating interventions within desired timeframes. This role involves effective collaboration and negotiation with patients, families, and healthcare teams to achieve patient and organizational goals related to care needs, choices, and satisfaction during discharge planning and care transitions. The position utilizes patient/family strengths in problem-solving, involving them and the team in decision-making from admission throughout the hospital stay. It ensures continuity of care and discharge planning services compliant with regulatory standards by providing coordinated options and services based on assessed needs, keeping patients, families, and the healthcare team informed. This includes facilitating smooth transitions during patient transfers. The role also provides case management services for various healthcare, financial, housing, family discord, or adjustment issues, managing family dynamics and crisis situations professionally, utilizing community resources, and educating patients/families on accessing and using services. The RN Care Manager Registry initiates internal and external referrals, documents interventions and utilization review activity per standards, and performs concurrent and retrospective reviews. Effective communication with the healthcare team, partnership with Social Work and unlicensed support personnel, and active participation in the Outcome Facilitation Team/Patient Care Multidisciplinary Team are crucial. Collaboration with managers, physicians, and treatment teams on physician practices and care plans, and referring cases to a physician advisor as needed are also key responsibilities. The role requires staying knowledgeable about healthcare regulations, reimbursement, length of stay impacts, and community resources, and completing UM activities including providing clinical updates to payers, collecting data, supporting UM activity, and managing avoidable delays. Delivering CMS regulatory notices within established timeframes and developing productive relationships with community agencies are also part of the role. The position serves as an educator and expert resource to staff regarding admission status, acute care criteria, UM issues, care coordination, discharge planning, and regulatory requirements. The incumbent must demonstrate age-specific knowledge and skills for patient care.

Requirements

Registered Nurse License issued by the state in which the Team Member practices.
Bachelor’s Degree in Nursing
2 years of clinical nursing experience.
Ability to prioritize and organize work.
Effective communication skills.
Utilization of critical thinking and timely decision making.
Ability to navigate the Electronic Health Record.
Basic utilization of MS Office products.
Knowledge of Medicare A and B guidelines.
Knowledge of Managed Care program requirements/implications.
Ability to apply elements of Utilization Management programs.

Responsibilities

Conducts complete assessments, establishes appropriate plans, and initiates interventions within desired timeframes.
Collaborates and negotiates effectively with patient, family, and team while striving to achieve patient and organizational goals with regard to patient’s care needs, choice and satisfaction when discharge planning/transitioning care.
Utilizes patient/family strengths in the problem-solving process, involving the patient/family and team in the decision-making process beginning on admission and continuing throughout patient’s hospital stay.
Provides continuity of care and discharge planning services compliant with regulatory standards by providing coordinated relevant options and services based on assessed needs to ensure patient/family and healthcare team is informed and able to proceed with accountabilities in a timely manner.
Provides case management services related to various levels of health care, finances, housing, family discord, or illness adjustment, based department scope.
Initiates internal and external referrals to assure timely progression of care and transitions.
Documents discharge planning interventions and utilization review activity per department and medical center standards in a timely manner.
Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria as required by department standards.
Communicates effectively with the healthcare team.
Works in partnership with Social Work and unlicensed support personnel to effectively establish and implement a safe plan of care.
Serves as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities.
Collaborates with managers, physicians, medical directors, advisory groups, and treatment teams for issues related to physician practices and best practices for the patient’s plan of care.
Refers cases to physician advisor as needed to ensure efficient progression of care, accurate status, and compliance with regulatory guidelines.
Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on length of stay and community resources.
Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.
Delivers CMS regulatory notices within CMS established timeframes, as appropriate based on-site guidelines.
Develops and maintains productive relationships with community-based agencies and networks by representing Advocate Aurora Health Care in a positive manner working collaboratively, internally, and externally, to meet patient/family needs.
Works in collaboration with Advocate Aurora Ambulatory Care Management and Continuing Health to meet common goals and outcomes.
Serves as an educator and expert resource to medical and hospital staff regarding admission status and acute care criteria, utilization management issues, care coordination and discharge planning needs, and relevant regulatory requirements.
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served.
Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures.

Benefits

Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
adoption assistance
paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program