RN Care Manager

GBMC HealthCare•Towson, MD

11d•$68,281 - $110,274

About The Position

Under general supervision, the RN Care Manager manages and coordinates inpatient care to facilitate quality, cost-effective outcomes. The role works collaboratively with interdisciplinary staff inside and outside the organization, coordinates with payers and physicians through utilization review to support maximum hospital reimbursement, and leads discharge planning and coordination of care. The position also collaborates with service-line team members to distribute patient caseloads. The Care Manager assesses patients’ clinical status, needs, issues, financial resources, and care goals; monitors care needs through rounds and communication with the healthcare team; and supports implementation of patient-centered plans across the continuum. The role reviews admission and continued-stay criteria, develops concurrent-stay and discharge plans consistent with payer and clinical guidelines, coordinates discharge services and post-discharge placement, and arranges referrals and community resources. It also addresses complex cases, payer authorization requirements, care coordination barriers, and staff education related to care management, outcomes, and documentation. The position is primarily based on clinical units, where the employee evaluates patient records, interviews patients and families, and works with interdisciplinary staff for up to 70% of the time. The remainder of the time is spent in an office environment using the phone or performing electronic documentation. The employee must be able to sit, stand, stoop, and bend, and must demonstrate knowledge of patient and workforce safety as well as competency in meeting age-specific patient needs when applicable.

Requirements

Bachelor of Science in Nursing (BSN), or Associate of Science in Nursing (ASN) and current enrollment in a BSN program with expected graduation within three years.
Two years of case management experience, including discharge planning and work with readmission initiatives.
Current Maryland Registered Nurse license, maintained on an ongoing basis.
Knowledge of care management theories, principles, and standards.
Skill using computer software programs.
Advanced oral and written communication skills.
Advanced critical-thinking skills.
Ability to resolve complex problems.
Ability to remain calm under pressure and intense time constraints.
Ability to assess patients’ discharge needs.
Ability to sit, stand, stoop, and bend.

Nice To Haves

Diversified, progressive experience in acute care and/or other settings within the continuum.
Care Management certification is highly desired.

Responsibilities

Assess patients within an assigned caseload to identify clinical status, needs, issues, financial resources, and care goals, including consideration of reimbursement mechanisms and available financial resources.
Continually assess care management needs through frequent rounds and communication with physicians and other healthcare team members; serve as a liaison to implement patient-centered plans across the continuum.
Review admission and continued-stay criteria for assigned patients and develop concurrent-stay and/or discharge plans in accordance with payer and clinical guidelines.
Identify, plan, modify, and coordinate discharge needs; make referrals and use available community resources to address continuing needs after acute care.
Maintain working knowledge of payer requirements and clinical criteria; coordinate services with managed-care companies and third-party payers, discuss reviewer issues, and obtain timely authorizations.
Coordinate post-discharge placement in another facility, including required pre-authorization, transportation, and communication of clinical information and service needs to the proposed facility.
Identify the need for, arrange, and conduct healthcare team meetings to coordinate care and discharge planning for complex patients and cases involving high resource utilization.
Educate physicians, ancillary staff, and nursing staff about care management, financial and clinical outcomes, and documentation requirements and standards.
Identify service-specific procedures and system obstacles that affect patient outcomes; consult with healthcare team members, recommend solutions, and collaborate with social work on complex discharge planning.
Keep management informed about clinically complex, emotionally intense, politically sensitive, and financially significant cases, and offer possible solutions through discussion and feedback.
Demonstrate GBMC Values, including respect, excellence, accountability, teamwork, ethical behavior, and results-oriented conduct.
Demonstrate knowledge and understanding of patient and workforce safety as they relate to job duties, and apply competency to age-specific patient needs when applicable.