RN Care Manager Solid Tumor & Neuro Oncology

Cincinnati Children's

2d•$81,723 - $104,208•Onsite

About The Position

Coordinate Complex Care. Support Families. Make a Difference. At Cincinnati Children’s, we come to work with one goal: to make children’s health better. Our Cancer & Blood Diseases Institute provides specialized, family-centered care to children and adolescents with some of the most complex medical conditions. We are seeking an experienced Registered Nurse Care Manager to join our Inpatient Oncology team supporting patients with Solid Tumor and Neuro-Oncology diagnoses. In this essential role, you will coordinate care for medically complex pediatric patients throughout their hospitalization and help ensure a safe and successful transition home and back to the community. You will work closely with physicians, nurses, advanced practice providers, social workers, therapists, case management partners, community agencies, and other members of the multidisciplinary team to identify patient and family needs and develop individualized plans of care.

Requirements

Current Registered Nurse license in the State of Ohio.
Bachelor of Science in Nursing (BSN).
Professional nursing experience demonstrating strong clinical judgment and care coordination skills.
Excellent communication, organization, critical-thinking, and problem-solving skills.
Ability to independently manage complex patient needs and competing priorities.
Ability to collaborate effectively within a multidisciplinary healthcare environment.
Current Registered Nurse license in the State of Ohio.
May be required to obtain other state licensure.
Bachelor's degree in a related field.
ACEN/CCNE accredited BSN OR MSN OR Associate/Diploma RN AND 2+ years of experience and BSN/MSN.
5+ years of work experience in a related job discipline.

Nice To Haves

Pediatric nursing experience.
Pediatric oncology or neuro-oncology experience.
Previous experience in care management, case management, or nurse navigation.
Experience with complex discharge planning and care transitions.
Experience coordinating home healthcare, durable medical equipment, infusion services, or community-based resources.
Oncology or pediatric nursing certification.

Responsibilities

Provide comprehensive care management for pediatric patients hospitalized with complex Solid Tumor and Neuro-Oncology diagnoses.
Coordinate care throughout the inpatient stay, from admission through discharge and transition to the next level of care.
Participate in multidisciplinary rounds and collaborate with the healthcare team to identify barriers, establish goals, and coordinate services.
Develop and facilitate individualized discharge plans based on the medical, developmental, psychosocial, and logistical needs of each patient and family.
Identify potential barriers to discharge early and proactively coordinate solutions.
Coordinate transitions between inpatient and outpatient care to promote continuity and prevent gaps in care.
Arrange home health, durable medical equipment, infusion services, transportation, community resources, and other supportive services as needed.
Provide education to patients and families regarding diagnoses, treatment plans, medications, follow-up care, and available resources.
Serve as a consistent point of contact and advocate for patients and families as they navigate complex healthcare needs.
Collaborate with oncology, neurology, neurosurgery, radiation oncology, surgery, rehabilitation, palliative care, social work, and other specialty services.
Communicate effectively with outpatient providers and community partners to ensure seamless transitions following hospitalization.
Monitor patient progress and adjust care coordination plans as clinical needs change.
Support patients and families experiencing complex psychosocial, financial, educational, and logistical challenges.
Promote safe, timely, and equitable access to necessary healthcare and community services.
Maintain accurate documentation of care management activities and discharge planning.
Evaluation and Outcomes - Evaluate the timeliness and availability of treatments and services and adjusting level of service according to changing needs. Evaluate actual patient outcomes in relation to expected outcomes for the care managed population. Identifies quality improvement opportunities such as consistent issues with smooth care progression and communicates them to the department's management/leadership team, providing supporting data and reference to evidence based practice when possible. Participates in the management of metrics (outcomes, value, and experience) across the continuum of care.
Monitoring - Monitor the patient's progress in achieving the goals, objectives, and expected outcomes of the plan at specified time frames. Utilizes Critical Pathways and /or Clinical Guidelines to monitor patient progress toward health. Follows through on the status of key diagnostic and treatment tests and procedures to insure continued progression. Interacts with involved departments and other members of the healthcare team to negotiate and expedite scheduling and completion of tests and procedures. Identifies, documents and communicates barriers to the plan of care to the healthcare team. Serves as the contact person for and works collaboratively with the multidisciplinary team to manage resource usage/utilization.
Coordination - Facilitates communication and coordination between members of the health care team across all phases of care. Involves the patient, family and caregivers in the decision-making process in order to minimize fragmentation in services. Leads the coordination of care, setting priorities and encouraging the appropriate use and timeliness of health care services Facilitates a smooth transition of care by ensuring that key components of the plan of care and/or patient needs are communicated to subsequent care providers across the continuum. Demonstrates an understanding of legal and regulatory issues (HIPPA, EMTALA, regulatory agencies, CMS, legal P&P) impacting the care delivery and reimbursement process. Negotiates and advocates for the patient for services and resources needed. Provides patient/family education regarding post-acute services, community resources, or other needs as identified. Creates an environment to support patient safety by integrating patient safety goals into daily practice based on the patient's age and the population served.
Implementation - Implementing the agreed upon plan of care. Provides self-management support to high risk/complex patients and families, including helping families identify and overcome barriers to care. Utilizes collaborative communication skills to establish a working partnership with the patient/family/caregiver, treatment team, and community resources/providers. Educates the patient, family and caregiver along with members of the health care delivery team about treatment options. Empowers the patient, family, and caregiver to problem-solve by exploring options of care when available and alternative plans, when necessary, to achieve desired outcomes. Encourages the appropriate use of health care services and strives to improve quality of care and maintain cost effectiveness on a case-by-case basis. Support and facilitate all care transitions from inpatient to outpatient, practice to practice and from pediatric to adult systems of care.
Planning - Planning with the patient, family or caregiver and providers, to maximize health outcomes and ensure quality, cost effective care. Works with the patient, family and caregiver, to establish treatment goals that meet the patient's healthcare and safety needs. Integrates patient, family and caregiver decisions and choice into the planning process. Coordinates the plan of care and maintains documentation of case updates and discussion/events involving individuals responsible for patient welfare (e.g. family, providers, and care team members). Identifies the need for patient/family team meeting, participates in the meeting and documents the outcomes. Proactively identifies medical and psychosocial services needed by the patient. Reassess plan of care and adjusts plan according to patient needs.