RN Case Manager

St. Charles Health System•Bend, OR

11d

About The Position

The RN Case Manager provides clinically based case management to support effective and efficient patient care. The role is accountable for utilization management and discharge planning for an assigned caseload, collaborating with the health care team to ensure appropriate use of resources. The position provides and oversees nursing care for assigned patients throughout the shift within the scope of RN licensure and does not directly manage other caregivers. The Case Manager assesses patient needs, evaluates medical necessity and continued-stay appropriateness, and develops discharge plans with patients, families, and the care team. The role coordinates clinical discharge needs, addresses barriers to discharge or transfer, supports patient and family education, and connects patients with appropriate community resources. The position also contributes to quality improvement, staff education, safe and therapeutic care, and the organization’s continuous improvement efforts. For an RN Case Manager assigned to the Emergency Department, duties also include identifying patients appropriate for case management, particularly high-risk and high-utilization patients; screening patients for admission or alternative community services; coordinating discharge needs and referrals; communicating medical necessity and level-of-care issues with attending physicians; notifying hospital case management about admissions needing follow-up; and educating physicians on inpatient and observation medical necessity criteria. The role may provide cross-coverage for other units and St. Charles sites. Occasional travel to community locations, other sites, or regional locations may be required for education, meetings, and training. The position requires the ability to wear required personal protective equipment.

Requirements

Graduate of an accredited school of nursing.
Current Oregon RN license.
AHA Basic Life Support for Healthcare Provider certification.
At least 3 years of clinical nursing experience in an acute care setting.
Knowledge of Quality Improvement.
Previous experience emphasizing disease management, patient education, and staff education.
Ability to wear appropriate personal protective equipment required to perform the job safely.

Nice To Haves

Bachelor of Science in Nursing (BSN).
Certification in Case Management.
Experience in case management and/or discharge planning.
Specialty experience such as cardiac, emergency department, oncology, orthopedics, or neuroscience.

Responsibilities

Use the nursing process to assess patient conditions and needs, establish outcomes, implement appropriate nursing actions, and evaluate progress.
Use appropriate criteria to confirm medical necessity for continued stay and evaluate patients’ continued-stay appropriateness using clinical information and screening criteria.
Develop discharge plans with patients, families, and the health care team that reflect patient needs and available resources.
Collaborate with team members to support patient and family learning during the hospital experience and prepare them for discharge.
Reinforce continued health care through teaching and referrals to community agencies.
Coordinate and document discharge plans with physicians, hospital administration, patients and families, registered nurses, and other disciplines.
Support outcomes such as reduced length of stay and cost per discharge, improved discharge procedures and patient satisfaction, and improved interdisciplinary interaction.
Manage clinical discharge-planning needs, including post-discharge parenteral and enteral needs, wound vac and complex wound care, clinical updates for placement, medication procurement for the initial 30 days, primary care physician assignment, and complex discharge issues.
Identify potential barriers to discharge or transfer, communicate them to the care team, and help resolve them where possible.
Schedule and lead complex patient discharge rounds and conferences with patients, families, and interdisciplinary teams as appropriate.
Serve as a patient care facilitator and liaison to internal services and external agencies.
Facilitate staff education and participate in quality improvement and evaluation processes related to case management practice.
Provide cross-coverage for other units and, as needed, other St. Charles sites.
Contribute to a healing environment and intentional relationships through caring, patient-centered communication and therapeutic presence.
Maintain a safe environment for caregivers, patients, and guests; document patient care in compliance with policies, procedures, and regulatory requirements.
Support the organization’s vision, mission, values, and Value Improvement Practice (VIP-Lean) principles of continuous improvement.
Conduct activities professionally and confidentially, comply with applicable laws and policies, and report known or suspected violations.
Deliver timely, efficient, accurate customer service and patient care; perform additional duties of similar complexity as assigned.
For Emergency Department assignments, screen and assess patients for case management, with emphasis on high-risk or target populations, potential admissions, and patients who may benefit from alternative placements or community services.
For Emergency Department assignments, provide referrals to community resources and explain them to patients and families; communicate with attending physicians about medical necessity and level of care; notify hospital case management of admissions needing follow-up; and educate physicians on inpatient and observation criteria.