RN Care Manager IP, WEO

Emory Healthcare•Johns Creek, GA

5h•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, high-quality clinical and cost outcomes, and securing post-acute services. They coordinate and advocate for patients and families with internal and external stakeholders, identifying and addressing barriers to care. The RN CM conducts thorough admission and psychosocial assessments to forecast potential barriers and develop discharge plans. They are an expert in assessment and forecasting, supporting others in this skill. As an integral part of the interdisciplinary care team, the RN CM attends rounds, care conferences, and meetings, balancing patient/family choice with care coordination needs. They proactively identify and recommend post-acute services, completing referrals in a timely manner, and continuously assess patient progress to ensure alignment of services with discharge dates and projected length of stay. The RN CM identifies and implements strategies to reduce unnecessary length of stay and resource consumption, functioning independently in formulating and navigating complex discharge plans. They act as a lead and resource to their team, facilitating family meetings and crucial conversations. The RN CM possesses expert knowledge of resources and advanced understanding of post-acute care, escalating cases to management, Physician Advisor, Complex Care team, or Ethics committee when appropriate. They educate patients, families, and the care team on post-acute services, transitions of care, readmission mitigation, and available resources, providing proactive supportive communication. 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 on 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, providing insight and guidance on 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
Successfully complete yearly competencies
Must meet expectations on yearly evaluation
May not have any active performance management or disciplinary action
Must obtain 12 CEU credits per year, related directly to core job functions, in addition to yearly competencies
Must 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

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
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 identifying and recommending 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
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 their 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 their team mates on regulatory requirements
Having advanced knowledge and ensuring proper use of Case Management Systems
Providing insight and guidance to systems and workflows
Serving as a lead to the Case Management team