RN Case Manager, Clinical Case Management, Full Time, First Shift

UC Health•West Chester, OH

About The Position

The RN Case Manager uses advanced nursing skills and knowledge of resource management and fiscal responsibility to coordinate clinical care for a designated patient population across the continuum of care. The role supports clinical effectiveness, discharge planning, care coordination, and clinical resource management, working with Medical, Nursing, and Ancillary department staff to promote quality-based, cost-effective outcomes and care in the most appropriate setting. The Case Manager collaborates with the health care team, patients, and families to plan and coordinate transitions of care, identify discharge barriers, arrange appropriate services and resources, and support safe, timely discharge. The role also performs utilization review to assess medical necessity, level of care, length of stay, and appropriate use of facility resources. Additional work includes patient and family education, quality improvement, data collection, professional development, and support for departmental quality initiatives.

Requirements

Registered Nurse graduate of an accredited school of Nursing, College, or University.
Current Ohio RN license.
At least three years of Home Health, Discharge Planning, and/or Case Management experience.
Current BLS (American Heart Association) certification at time of hire.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred.
Certification in Case Management or Certified Professional in Health Care Quality (CPHQ) encouraged.

Responsibilities

Engage in population-appropriate communication and involve patients' families or guardians in assessment, treatment, and continuing care.
Collaborate with the health care team on care plans, referrals, and ongoing patient needs, and coordinate communication with resident and attending physicians.
Review selected cases within one business day of admission and throughout the stay to assess and execute transition-of-care planning requirements.
Conduct face-to-face brief screens for appropriate patients within one business day of admission, identify discharge barriers, and document findings in MR Progress Notes.
Facilitate timely tests and procedures, obtain lab results, and discuss discharge implications with nursing staff and residents as needed.
Evaluate patients' responses to pharmacological and therapeutic treatment regimens with the team.
Collaborate on discharge forms, paperwork, and prescriptions, and identify and address actual or potential service delays with patients, families, caregivers, and relevant teams.
Coordinate patient care conferences based on patient and family needs and ensure appropriate information and education are provided before transition to the next level of care.
Identify and resolve discharge-related problems, implement plans of care, and coordinate safe and timely discharges.
Arrange skilled home care, medical equipment, and supplies needed for home care services; coordinate infusions, enteral care, and treatments with providers and discharge timing.
Collaborate with home care providers regarding benefits and coverage, and advocate, mediate, and negotiate plans that support patient health and safe transitions.
Consult with and train medical staff and other health care professionals on discharge and home care issues; identify service-delivery barriers and help develop improvements.
Identify and provide or refer patients and families to available resources, and coordinate education regarding care plans and health care needs.
Develop, revise, and evaluate tools that facilitate care coordination and patient care standards.
Participate in process improvement, quality improvement, and evaluation of patient outcomes for specific populations.
Collect data on clinical resource management, length of stay, readmissions within 30 days, and other identified patient outcomes.
Make post-discharge calls to patients discharged with home care or durable medical equipment to confirm after-care arrangements are successful.
Review assigned patients to ensure admissions, continued stays, and ancillary services are medically necessary and provided in the appropriate setting.
Use the Allscripts/ECIN work list to determine daily assignments and perform concurrent chart reviews.
Evaluate initial level of care and patient type, discuss admission criteria and expected length of stay with the care team, and seek clinical findings and documentation supporting criteria and guidelines.
Escalate cases to the Clinical Manager when appropriate for review and resource allocation.
Support quality initiatives under department leadership and demonstrate customer-focused interpersonal skills, problem solving, and critical thinking.
Communicate and resolve conflicts with physicians, health care team members, community agencies, clients, and families with diverse opinions and cultural or religious ideas.
Perform other assigned duties, including participation in planning sessions for departmental activities.
Attend appropriate clinical and professional organizations, workshops, and meetings; stay current on community resources and clinical advancements relevant to the patient population.
Proactively seek to understand roles and areas outside the immediate role within the department.