RN Case Manager

Carilion Clinic•Roanoke, VA

19h•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.

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 positive interpersonal oral communication skills.
Demonstrate effective written communication skills.
Demonstrate integrity, innovation, team player, courteous qualities.
Ability to resolve complaints/problems.
Customer-focused philosophy of service delivery.
Ability and 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 assertiveness, flexibility, perseverance, diplomacy and negotiation.

Nice To Haves

Supervisory or leadership experience is preferred.

Responsibilities

Provide case management for assigned patient populations.
Utilize clinical expertise, communication, and problem-solving skills to achieve optimal clinical and resource outcomes.
Promote cost-effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization.
Perform patient needs assessments upon admission and at regular intervals.
Facilitate referrals and provide linkages to health, wellness, and post-acute care resources across the health care continuum.
Promote interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan.
Promote 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.
Collaborate with Utilization Review Nurse and maintain regular contact throughout the day.
Use InterQual software to support accurate patient statuses according to ongoing medical necessity and integrate information during unit huddles.
Aid in the delivery of regulatory letters and patient notices related to insurance coverage/non-coverage (e.g., IM, HINN).
Ensure documentation accurately reflects the patient’s condition, co-morbidities, treatment, and procedures that support the most appropriate admission status and DRG assignment.
Communicate with patients/families to ensure understanding of financial implications of discharge plans.
Facilitate an interdisciplinary approach to patient care and actively participate in Interdisciplinary Team Meetings on assigned units.
Provide 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, and manage changes as necessary.
Maintain effective communications with all disciplines to promote timely and appropriate discharges, including daily communication with Social Work and Utilization Review.
Coordinate care and services within the case managed population.
Perform face-to-face assessments of patients/families when appropriate to identify individualized needs in collaboration with Social Work.
Review assigned census daily with the Social Worker partner to determine patient statuses and needs.
Complete documentation in the medical record in the appropriate time frame, accurately reflecting the plan of care and CM interventions.
Comply with CMS regulations related to discharging planning documentation.
Coordinate referrals of post-acute services such as home health (HH), hospice, and durable medical equipment (DME).
Direct liaison activities to appropriately integrate with the patient and into the health care continuum.
Facilitate appropriate referrals surrounding high-cost medications for all patients, insured or uninsured.
Work 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 (e.g., RX Help, CMAP, Medication Investigations).
Ensure coordination of care when patients are transferred: acute hospital to acute hospital, and jails/prisons.
Communicate with outside nursing or case management staff as appropriate for smooth transition and communicate post-acute care needs of inmates.
Advocate for the patient and family throughout the entire episode of care.
Participate in departmental and system performance improvement Initiatives.
Contribute to Carilion Clinic’s performance improvement activities by engaging with predictive analytic software.
Collect and analyze relevant patient care and fiscal data.
Analyze and evaluate the effect of case management on quality outcomes and fiscal parameters.
Comply with all departmental policies and practices and foster teamwork and professionalism.
Participate in Unit-based IDR morning and afternoon huddles.
Reassess patients and document status of referrals, movement on barriers.
Maintain awareness and anticipate unit-based patient needs.
Provide hand-off communication of unit needs to peers during weekday/weekend transitions.