RN Care Manager -PSMC

Phoebe Putney Health System•Sumter, SC

14d•Onsite

About The Position

The Nurse Case Manager coordinates patient care throughout the continuum from entry through discharge for patients receiving inpatient and observation services. The role supports appropriate and timely admission, care, and discharge; conducts first-level clinical reviews using approved clinical criteria and payer requirements; and promotes efficient use of resources at the appropriate level of care. Working with social work, physicians, nurses, and the interdisciplinary team, the Care Manager supports quality, timely, and cost-effective care, addresses readmission issues, and facilitates patient progression through a defined plan of care. Under the direction of the Care Management Team Lead and Director of Care Management, the Care Manager develops, facilitates, and implements case management and discharge plans. The position performs utilization review and discharge or transition planning, including prospective, concurrent, and, as required, retrospective reviews. It assesses patient and family needs, coordinates care across acute and post-acute settings, identifies barriers and delays, supports safe transitions, and documents reviews, referrals, activities, and outcomes in the appropriate electronic system. The Care Manager also contributes to staff education, teamwork, leadership, and quality-improvement efforts, including work to understand and address readmission patterns.

Requirements

Associate's Degree in Nursing from a state-accredited school.
At least 1 year of recent acute-care experience with relevant clinical experience in the assigned area.
Current Registered Nurse (RN) license in Georgia.

Nice To Haves

Bachelor's Degree in Nursing from a state-accredited school.
At least 1 year of case management or utilization review experience in a hospital or related setting.
Certified Case Manager certification upon hire.

Responsibilities

Coordinate patient care from point of entry through discharge for inpatient and observation patients.
Perform first-level clinical reviews using approved clinical criteria, the Care Management Program's Utilization Plan, and payer-specific requirements.
Conduct utilization review and discharge or transition planning for the assigned caseload or unit, including prospective or concurrent reviews and retrospective reviews when required.
Apply regulations and payer requirements to support compliance, protect patient rights, and help avert denials or patient liability.
Escalate physician, patient-care, quality, or case-management issues to the appropriate physician adviser, utilization officer, Team Lead, or Director.
Educate physicians, nurses, hospital personnel, patients, and families about care-management processes, regulations, discharge options, and transition needs.
Ensure an appropriate plan of care and discharge plan is established, intervening and facilitating as needed.
Assess patient clinical, emotional, cultural, psychosocial, family, and financial needs relevant to treatment and discharge planning.
Identify risk factors, delays in care, and needs for referrals to appropriate disciplines, agencies, or community resources.
Coordinate care among caregivers and across acute and post-acute settings, collaborating with social workers and the interdisciplinary team.
Engage patients and, when appropriate, family or significant others in care planning and decisions.
Develop individualized plans, identify expected outcomes, reassess needs, evaluate responses and outcomes, and document evaluations.
Identify and assess patterns, trends, and root causes of readmissions and work with relevant disciplines to address patient-specific and broader issues.
Participate in quality-improvement activities, projects, committees, and efforts to improve care coordination, patient flow, and hospital efficiency.
Document reviews, referrals, transition-planning activities, follow-up, and outcomes accurately and promptly in the appropriate electronic system.
Maintain current professional knowledge, attend meetings and required training, complete competency requirements, and perform other duties as required.