RN Case Manager

Carilion Medical Center•Roanoke, VA

1d•Onsite

About The Position

The RN Case Manager provides case management for assigned patient populations. Utilizes clinical expertise, communication and problem-solving skills to achieve optimal clinical and resource outcomes. Promotes cost-effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization. Performs patient needs assessments upon admission and at regular intervals, facilitating referrals and providing linkages to health, wellness, and post-acute care resources across the health care continuum. Promotes interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan. Promotes appropriate length of stay, resource management, and care transitions to the next level of care. Must comply with all federal and state regulations surrounding the discharge process. Must possess knowledge of growth and development appropriate to age group served and incorporate plan to meet needs into plan of care. The role involves collaboration with Utilization Review Nurses, maintaining regular contact, and using InterQual software for accurate patient statuses. It also includes aiding in the delivery of regulatory letters, ensuring accurate documentation of patient conditions, and communicating financial implications of discharge plans to patients/families. The RN Case Manager facilitates an interdisciplinary approach to patient care, actively participates in Interdisciplinary Team Meetings, provides feedback to the healthcare team, and manages changes to the plan as necessary. Daily communication with Social Work and Utilization Review is essential. The position coordinates care and services, performs face-to-face assessments, reviews assigned census with SW partners, and ensures timely and accurate documentation. It also involves coordinating referrals for post-acute services like home health, hospice, and DME, and facilitating referrals for high-cost medications. The RN Case Manager ensures coordination of care during patient transfers (acute hospital to acute hospital, and jails/prisons) and communicates with outside nursing or case management staff for smooth transitions. Advocating for the patient and family throughout the entire episode of care is a key aspect. The role also includes participation in departmental and system performance improvement initiatives, contributing to Carilion Clinic’s performance improvement activities by engaging with predictive analytic software, and collecting/analyzing patient care and fiscal data to evaluate the effect of case management on quality outcomes and fiscal parameters. Compliance with departmental policies and fostering teamwork and professionalism are also expected.

Requirements

Registered Nurse
Bachelor's degree required
5 years of RN experience in a hospital setting (may be considered in lieu of a bachelor's degree)
Three years of recent experience in a clinical health care setting with responsibilities reflecting direct management of patient care including planning, coordination, and delivery of needed services such as education, psychosocial support, discharge planning and utilization management
Current licensure in Virginia as a Registered Nurse
AHA BLS- HCP required within 6 months of hire
Demonstrate knowledge and competency in satisfactory completion of orientation
Demonstrate knowledge and competency in positive interpersonal oral communication skills
Demonstrate knowledge and competency in effective written communication skills
Demonstrate knowledge and competency in integrity
Demonstrate knowledge and competency in innovation
Demonstrate knowledge and competency in team player
Demonstrate knowledge and competency in courteous
Demonstrate knowledge and competency in ability to resolve complaints/problems
Demonstrate knowledge and competency in customer-focused philosophy of service delivery
Demonstrate knowledge and competency in ability
Demonstrate knowledge and competency in willingness to work as an integral member of a multi-skilled team
Demonstrate knowledge and competency in computer literacy
Demonstrate knowledge and competency in community and system resources
Demonstrate knowledge and competency in effective interpersonal relations
Demonstrate knowledge and competency in assertiveness
Demonstrate knowledge and competency in flexibility
Demonstrate knowledge and competency in perseverance
Demonstrate knowledge and competency in diplomacy and negotiation

Nice To Haves

Supervisory or leadership experience is preferred

Responsibilities

Provides case management for assigned patient populations
Utilizes clinical expertise, communication and problem-solving skills to achieve optimal clinical and resource outcomes
Promotes cost-effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization
Performs patient needs assessments upon admission and at regular intervals, facilitating referrals and providing linkages to health, wellness, and post-acute care resources across the health care continuum
Promotes interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan
Promotes appropriate length of stay, resource management, and care transitions to the next level of care
Comply with all federal and state regulations surrounding the discharge process
Possess knowledge of growth and development appropriate to age group served and incorporate plan to meet needs into plan of care
Collaborates with Utilization Review Nurse
Maintains regular contact with assigned Utilization Review Nurse throughout the day
Uses InterQual software to support accurate patient statuses according to ongoing medical necessity
Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non-coverage, using support staff as appropriate
Ensures documentation accurately reflects the patient’s condition, co-morbidities, treatment and procedures that support the most appropriate admission status and DRG assignment
Communicates with patients/families to ensure understanding financial implications of discharge plans
Facilitates an interdisciplinary approach to patient care
Actively participates in Interdisciplinary Team Meetings on assigned units, sharing meaningful and professional knowledge to the team discussion regarding progression of care
Provides feedback to the health care team verbally and via chart entries regarding the patient's progress toward reaching expected outcomes or about barriers to the plan
Manages changes to the plan as necessary
Maintains effective communications with all disciplines to promote timely and appropriate discharges
Daily communication with Social Work and Utilization Review: includes case reviews, morning touchpoints, and ongoing throughout the workday
Coordinates care and services within the case managed population
Performs face-to-face assessments of patients/families when appropriate to identify individualized needs in collaboration with SW
Review assigned census beginning each day with their SW partner to determine patient statuses and needs for the day
Documentation in the medical record is completed in the appropriate time frame, accurately reflecting the plan of care and CM interventions
Complies with CMS regulations related to discharging planning documentation
Coordinates referrals of post-acute services such as home health (HH), hospice, and durable medical equipment (DME)
Directs liaison activities to appropriately integrate with the patient and into the health care continuum
Facilitates appropriate referrals surrounding high-cost medications for all patients, insured or uninsured
Works with other disciplines along with support staff to obtain prior authorizations and/or co-pay information to ensure medication needs are met for discharge and do not create a barrier
Ensures coordination of care when patients are transferred: acute hospital to acute hospital, and jails/prisons
Communicates with outside nursing or case management staff as appropriate for smooth transition
Advocates for the patient and family throughout the entire episode of care
Participates in departmental and system performance improvement Initiatives
Contributes to Carilion Clinic’s performance improvement activities by engaging with predictive analytic software
Collects and analyzes relevant patient care and fiscal data
Analyzes and evaluates the effect of case management on quality outcomes and fiscal parameters
Complies with all departmental policies and practices and fosters teamwork and professionalism
Participate in Unit-based IDR morning and afternoon huddles
Coordinate referrals for DME, HH, Hospice
Utilize predictive analytic software (example: JVION)
Complete face-to-face patient assessments
Communicate with assigned UR nurse and SW partner
Reassess patients and document status of referrals, movement on barriers
Aids in the delivery of regulatory letters (IM, HINN)
Integrates InterQual information during unit huddles and throughout workday as appropriate
Provides Medication Assistance to patients identified in need (RX Help, CMAP)
Initiates Medication Investigations (need for authorization, obtain co-pay information)
Communicate post-acute care needs of inmates during transitions back to jail
Assist in acute-acute and transitions of care
Maintain awareness and anticipate unit-based patient needs
Provide hand-off communication of unit needs to peers during weekday/weekend transitions