RN Case Management Manager | Lead Patient Care & Care Transitions

The Staff Pad•Hamilton, TX

5d•Onsite

About The Position

The Case Management Manager leads and supports the Case Management team in coordinating patient care from admission through discharge. This role collaborates closely with physicians, nursing staff, and interdisciplinary teams to remove barriers to timely discharge, improve patient outcomes, ensure regulatory compliance, and promote cost-effective care while maintaining the highest standards of patient advocacy.

Requirements

Graduate of an accredited School of Nursing
RN license in the State of Texas
Current CPR, BLS certification
5+ years of Registered Nurse experience
Knowledge of utilization management, discharge planning, and regulatory requirements
Compassionate and patient-focused leadership
Excellent communication, relationship-building, clinical judgement and problem-solving skills
Commitment to quality, safety, and continuous improvement
Ability to multitask and perform in a fast-paced environment
Ability to stand, walk, bend, lift up-to 50 pounds, and assist patients as needed

Nice To Haves

ACLS preferred
Case Management leadership experience preferred

Responsibilities

Conduct discharge assessments on admission & develop timely, appropriate discharge plans
Perform daily patient assessments, monitor, evaluate & document patient progress
Coordinate post-hospital care & coordinate discharge to home and other care settings
Provide, document, and coordinate patient and family education; serve as liaison among patients, families, physicians, and the care team
Document discharge services accurately and timely in accordance with hospital policy
Maintain individualized patient care plans and update them based on changes in patient status
Review denials, identify appeal needs, and ensure appropriate appeal completion
Review continued stay, medical necessity, medical reports and treatment plans
Facilitate access to financial assistance, advance directives, legal aid, education and medication assistance programs
Coordinate patient care and rehabilitation using consultation findings and social work expertise
Partner with Quality Improvement to enhance patient safety, establish goals, and submit monthly quality reports
Review payer-requested charts and communicate clinical information to payers
Maintain referral source database & refer patients, families to community resources
Identify barriers to patient progress & perform social work duties as needed
Document ongoing physiological, psychosocial assessments, patient and family education and responses & interdisciplinary care plan recommendations
Validate, transcribe, and co-sign physician orders; report patient progress, and advise physicians and departments on utilization management regulations
Perform utilization reviews in compliance with state regulations and evolving utilization management regulations
Monitor daily case management needs & maintain collaborative staff relationships
Communicate discharge plans with physicians and complete follow-up calls within three days of discharge
Assist with coordinating quarterly utilization review committee activities and updating policies and procedures
Perform registered nurse duties in accordance with the RN job description
Maintain confidentiality and HIPAA compliance when handling sensitive information
Adhere to organizational behavioral standards personnel policies and customer service expectations
Perform other duties as assigned