RN Care Manager - Phoebe Sumter Hospice

Phoebe Putney Health System•Sumter, SC

13d•Onsite

About The Position

The Nurse Case Manager is responsible for coordinating patient care from entry through discharge, addressing appropriate and timely admission, discharge, and care for patients receiving inpatient and observation services. The role performs first-level clinical reviews using hospital-approved criteria and the Care Management Program’s Utilization Plan and payer requirements, and promotes efficient, effective care at the appropriate level. The Care Manager collaborates with social work, physicians, nurses, and the interdisciplinary team to provide quality, timely, and cost-effective case management, facilitate patient progression under a defined plan of care, and address readmission issues and patterns. 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 role includes utilization review, discharge and transition planning, patient and family education, clinical and psychosocial assessment, care coordination across acute and post-acute settings, and identification of barriers or delays in care. The Care Manager documents reviews, referrals, transition-planning activities, and outcomes in the appropriate electronic system; contributes to performance improvement; and supports staff, physicians, patients, and families in understanding care management processes.

Requirements

Associate’s Degree in Nursing from a state-accredited school.
At least 3 years of recent acute care experience with relevant clinical experience in the assigned area.
Current Registered Nurse (RN) license in Georgia.
Knowledge of current federal, state, and accreditation requirements applicable to utilization review and discharge planning.
Ability to perform utilization review, discharge and transition planning, clinical assessment, and care coordination responsibilities.
Ability to document accurately and use appropriate terminology and required documentation formats.

Nice To Haves

Bachelor’s Degree from a state-accredited School of Professional Nursing.
At least 1 year of Case Management or Utilization Review experience in a hospital or related setting.
Certified Case Manager (CCM).

Responsibilities

Coordinate patient care from point of entry through discharge, including appropriate and timely admission, discharge, and care.
Perform first-level, prospective, concurrent, and as required retrospective utilization reviews using established clinical criteria and applicable payer requirements.
Support efficient and effective use of resources and care delivery at the appropriate level of care.
Develop and facilitate case management, discharge, and transition plans in coordination with physicians, nurses, social workers, and the interdisciplinary team.
Assess patient and family clinical, treatment, emotional, cultural, psychosocial, and financial needs relevant to care and discharge planning.
Coordinate care among caregivers and across acute and post-acute settings; engage patients and families in planning and decisions as legally appropriate.
Educate patients and families about discharge services, care options, providers, payer authorizations, and actions needed to meet financial obligations for transition planning.
Identify risks, barriers, delays in care, and potential quality, medical-necessity, authorization, or payment issues; intervene or escalate as appropriate.
Notify or consult physician leadership and Care Management leadership regarding physician, patient-care, or quality issues as needed.
Educate physicians, nurses, and other hospital personnel about care management processes and payer or regulatory policies.
Evaluate patient outcomes and care plans, document assessments and results, and revise plans as patient needs and responses change.
Assess readmission patterns, trends, and causes and collaborate with the care team to address patient-specific issues and prevent future readmissions.
Participate in quality and performance improvement activities, projects, committees, and shared decision-making opportunities.
Maintain knowledge of relevant regulations, accreditation requirements, professional practices, and assigned responsibilities.
Document reviews, referrals, follow-up, transition-planning activity, and outcomes accurately and promptly in the appropriate electronic system.
Attend staff meetings, complete required education and competency evaluations, follow attendance guidelines, and perform other duties as required.
Demonstrate competency in providing care to patients based on age, sex, weight, and demonstrated needs; use protective clothing and equipment as appropriate.