RN Care Manager IP, WEO

Emory•Johns Creek, GA

22h•Onsite

About The Position

The RN Case Manager (RN CM) is responsible for patient care coordination from admission through discharge, ensuring smooth transitions of care and facilitating high quality clinical and cost outcomes. This role involves procuring post-acute services, coordinating and advocating for patients and families with internal and external stakeholders, and identifying barriers to care coordination/discharge planning to foster efficient care delivery and maximize reimbursement. The RN CM conducts thorough admission and psychosocial assessments to forecast potential barriers and initiate discharge planning. They are an integral part of the interdisciplinary care team, attending rounds and meetings, and balancing patient/family choice with service execution. The RN CM proactively identifies and recommends post-acute services, completing timely referrals and continuously assessing alignment with patient clinical progression. They ensure the discharge plan aligns with the patient's medically cleared for discharge date and projected length of stay, implementing strategies to reduce unnecessary length of stay and resource consumption. The RN CM functions independently in assessing and formulating discharge plans, coordinating complex cases, and acts as a lead and resource to their team. They are expert in facilitating family meetings and crucial conversations, possessing advanced knowledge of resources and post-acute care. The RN CM escalates cases as appropriate and educates patients, families, and the care team on post-acute services, transitions of care, readmission mitigation, and available resources. They provide proactive supportive communication for patients and families experiencing stress. The RN CM communicates confidently and assertively, advocating for patients and the hospital with payors to reduce non-covered services. They independently issue notices of non-coverage and potential liability, guiding teammates through this process. The RN CM serves as an expert resource for interpreting external regulations and organizational policies related to Discharge Planning and Care Coordination, ensuring compliance with third-party payers and regulatory agencies. They have advanced knowledge and ensure proper use of Case Management Systems and workflows, providing insight and guidance to systems and workflows, and serving as a lead to the Case Management team.

Requirements

Must have a valid, active unencumbered Nursing license or temporary permit approved by the Georgia Licensing Board
Bachelor's degree in nursing required
3-5 years experience in Case Management (CM) required
3-5 years healthcare experience required
Case Management certification required
CM RN Nurse II for 1 year
Must meet all quality and productivity expectations and successfully complete yearly competencies
Must meet expectations on yearly evaluation and may not have any active performance management or disciplinary action
Successful completion of yearly competencies
Must obtain 12 CEU credits per year, related directly to core job functions, in addition to yearly competencies

Responsibilities

Responsible for patient care coordination from admission through discharge
Ensuring smooth transitions of care as the patient is discharged from the hospital setting
Ensuring and facilitating high quality clinical and cost outcomes
Procuring and securing post-acute services
Coordinating and advocating for patients and families with both internal and external stakeholders
Identifying and addressing potential barriers to care coordination/discharge planning in an effort to foster efficient care delivery and maximize reimbursement
Independently completing a thorough admission assessment and/or psychosocial assessment
Attending rounds, care conferences, and/or care team meetings
Acting as a representative of both the hospital care team and the patient/family
Working with the hospital care team and the patient/family in order to plan and implement the best possible plan for the patient
Proactively identify and recommend post-acute services
Completing referrals to appropriate post-acute care providers in a timely manner
Coordinating directly with the patient/family as well as the care team
Applying critical thinking and acquired clinical knowledge to ensure alignment and appropriateness of post-acute services
Ensuring the discharge plan is aligned to be executed with the patient's medically cleared for discharge date as well as the projected length of stay as provided by the payor
Identifying and implementing strategies to reduce unnecessary length of stay and/or resource consumption
Functioning independently while assessing and formulating discharge plans
Successfully coordinating and navigating clinically and socially complex cases independently
Acting as a lead and resource to their team to provide support and guidance for success
Initiating and facilitating family meetings, care conferences, and crucial conversations
Escalating cases, as appropriate, to management, Physician Advisor, Complex Care team and/or Ethics committee
Educating patients/families as well as the care team as it relates to post-acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices and available resources
Anticipating and providing proactive supportive and therapeutic communication for patients, families and loved ones who are experiencing anxiety or stress due to illness, injury or physical limitations
Proactively initiating and facilitating discussions with the payors in order to act as an advocate on behalf of the patient and hospital
Independently issuing and administering notices of non-coverage and potential liability to patients in accordance with predetermined regulations, policies, and procedures
Supporting and guiding teammates through the notice of non-coverage process
Serving as an expert resource to the Physician, Interdisciplinary Care Team, and patient for the interpretation of external regulations and organizational policies and procedures as it pertains to Discharge Planning and Care Coordination
Ensuring compliance with all third party payers and federal and state regulatory agencies
Guiding teammates on regulatory requirements
Having advanced knowledge and ensuring proper use of Case Management Systems and having an in depth understanding of workflows
Providing insight and guidance to systems and workflows
Serving as a lead to the Case Management team
Actively identify and successfully lead at least one process improvement initiative
Complete 4 electives such as projects, presentations, super user role related to core job functions