RN-Case Manager- Medical Alt - Memphis

Baptist • Memphis, TN

3d

About The Position

Case Managers use systems, science, incentives, and information to improve healthcare practice and help patients and their support systems participate in a collaborative process for more effective management of medical, social, and mental health conditions. The role aims to optimize patient wellness, improve care coordination, and provide cost-effective, non-duplicative services. The Case Manager performs other duties as assigned.

The Case Manager assesses patients’ clinical, psychosocial, and financial needs, including available support, readmission risk, discharge safety, and payer benefits. The role uses InterQual criteria to determine and validate level and intensity of care, conducts initial and concurrent reviews, coordinates patient placement, and collaborates with physicians and case management leadership to resolve review conflicts.

Working with physicians, patients, families, nursing, ancillary departments, and social work, the Case Manager develops and monitors plans of care, estimated lengths of stay, and discharge or transition plans. The role coordinates services and resources, addresses barriers and gaps in care, supports timely and appropriate transitions, documents variances, and maintains knowledge of facilities and resources available to patients and caregivers.

Requirements

• At least 3 years of healthcare/medical acute-care experience.
• Graduate of an accredited school of nursing.
• Valid State of Mississippi Registered Nurse (RN) license.
• Ability to work with acutely and chronically ill patients of all ages and their caregivers.
• Excellent interpersonal communication, multitasking, prioritization, and organizational skills.
• Demonstrated ability to work effectively and collaboratively with teams and escalate issues appropriately.
• Ability to work weekends and flexible hours according to the department staffing plan.

Nice To Haves

• Healthcare/medical case management experience.
• Healthcare/medical utilization review experience.
• Bachelor’s degree in nursing or allied health.
• Certification by the Case Management Society of America or equivalent certification.

Responsibilities

• Assess and document patients’ clinical, psychosocial, and financial needs, including available care support, readmission risk, discharge safety, payer benefits, and potential care management and discharge needs.
• Use InterQual criteria within the first 24 hours of arrival to determine or validate level of service and intensity of care; collaborate to resolve conflicts and coordinate appropriate placement.
• Conduct concurrent medical record reviews to ensure continued appropriateness of care, make recommendations, and escalate and facilitate resolution of care that varies unjustifiably from InterQual guidelines.
• Work with physicians to identify the plan of care, estimated length of stay, and transition or discharge plan; engage patients and families, incorporate relevant processes and services, and adjust plans as the patient’s condition indicates.
• Collaborate with social work on complex post-acute placement and community service resources.
• Coordinate with nursing, ancillary departments, social work, and physicians to monitor completion of treatment and transition or discharge plans and avoid gaps, duplicative services, and unnecessary services.
• Ensure timely and appropriate discharge or transition and document variances from the plan or target date.
• Escalate concerns and barriers to appropriate treatment or transition according to department processes.
• Maintain working knowledge of facilities and resources available to patients and caregivers.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree