RN Case Manager - Inpatient U of U Hospital

University of Utah Health•Salt Lake City, UT

About The Position

This position provides clinical case management services to enhance patient-centered care and maximize outcomes across the care continuum, from pre-admission through post-discharge. The case manager monitors progress toward desired outcomes, addresses patient and family needs, resolves barriers to effective care, coordinates services with payers and vendors, and works with patients, families, and internal team members to establish, monitor, and execute discharge plans. The position may involve accessing and administering medications within the employee’s scope of practice and in accordance with state law. The University of Utah is a Level 1 Trauma Center recognized for academic research, quality standards, and patient experience. University of Utah Health’s mission is to enhance people’s health and well-being through patient care, research, and education, supported by a culture of collaboration, excellence, leadership, respect, compassion, innovation, responsibility, integrity, quality, and trust. The role may require rotating schedules, including variable hours, weekends, nights, and holidays, to meet staffing and patient-care demands in a 24/7 health system. Reliable and punctual attendance during assigned shifts is an essential function. The position involves light work, may require moving objects or patient-care and medical equipment, and does not provide direct patient care. Workers may be exposed to infectious diseases and may work around prisoners or behavioral health patients.

Requirements

Two years of professional experience in a clinically related area.
A current Utah license to practice as a Registered Nurse, or obtain one within 90 days of hire under the interstate compact when changing residency to Utah; maintain a current interstate compact multi-state license if residency is not changing to Utah. Alternatively, one of the other specified professional licenses is required: Utah Licensed Clinical Social Worker certificate, Utah Clinical Mental Health Counselor license, Utah Physical Therapist license (or obtain one within 90 days under the Physical Therapy Compact when changing residency to Utah), or Utah Occupational Therapist licensure.
Additional license requirements may be determined by the hiring department.
Ability to perform the essential functions of the job.
Demonstrated availability to work variable and rotating shifts, including nights, weekends, and holidays, in a 24/7 patient-care environment.
Demonstrated team leadership, relationship-building, critical-analysis, and written and verbal communication skills.
Knowledge of funding resources, clinical standards, and outcomes.
Ability to provide care appropriate to the population served.
Independent judgment in assessing and meeting client needs, and ability to conduct meaningful, outcome-oriented dialogues with patients, families, care disciplines, ancillary departments, healthcare and community agencies, third-party payers, and Health Sciences Center professional schools to coordinate care and services.
Knowledge and skills necessary to provide care appropriate to the age of patients served in the assigned area.
Knowledge of lifespan growth and development principles and ability to assess patient-status data and provide care as described in departmental policies and procedures.
Ability to meet the position’s physical requirements with or without accommodation.
Reliable transportation may be required for site visits, depending on the department of hire.

Nice To Haves

Basic Life Support Health Care Provider card through the American Heart Association.
Certified Case Management designation.
Previous experience in clinical resource management activities and third-party payer interactions.

Responsibilities

Coordinate case management from a patient’s entry into the healthcare system through post-discharge, including outpatient settings, coordinating care and resources with physicians, social workers, and other team members.
Identify patients suitable for case management based on factors such as cost, case complexity, admission frequency, or requests from patients, families, providers, or other healthcare team members.
Monitor and document quality of care; ensure care-plan goals are appropriate, understood, and implemented; assess patient and family responses; evaluate care-plan effectiveness and necessity; and identify and address ethical and cultural needs.
Facilitate cost-effective outcomes by determining the appropriate level of care using diagnosis, severity, service intensity, national and regional length-of-stay standards, and community norms.
Assess and discuss funding and insurance issues with patients, families, and healthcare providers to support cost-effective service use and quality outcomes.
Negotiate with third-party payers regarding benefit levels, eligibility, utilization review, and reimbursement.
Identify actual and potential delays in services or treatment and communicate them to the healthcare team to minimize or eliminate delays.
Work with team members to plan appropriate and timely discharges.
Establish measurable discharge-planning and self-management goals that promote safe, cost-effective, high-quality outcomes.
Provide oversight of issuance of the CMS Important Message to patients.
Supervise technical support staff assigned to case-management teams.
As needed, arrange patient follow-up appointments and conduct post-discharge phone calls according to care-team design.
As needed, complete home or site visits.
Work rotating schedules, which may include variable hours, weekends, nights, and holidays, according to department operational and patient-care needs.