RN Case Manager, UofL Hospital

UofL Health•Louisville, KY

3d•Onsite

About The Position

The RN Case Manager promotes optimal health care outcomes in accordance with UofL Health policies, procedures, applicable laws and contracts, and the organization’s philosophy, mission, vision, and values. The role supports appropriate use of facilities and services, serves as a resource to physicians, nurses, and ancillary staff, conducts admission assessments, identifies patients who may not meet criteria for their current level of care, and helps ensure they receive the most appropriate care. The RN Case Manager participates in daily rapid rounds and coordinates care and discharge planning with the interdisciplinary health care team. The role uses nursing and management processes to guide decision-making, maintains confidentiality, and supports organizational goals by providing information to divisions and departments. Under the direction of the Manager or Director of Care Coordination or the CNO, the RN Case Manager supports the Care Coordination Department. This includes assessing patient needs and appropriate levels of care, developing and updating patient-specific plans of care in the electronic medical record, coordinating discharge needs, documenting care, advocating for patients and families, and facilitating communication among patients and the interdisciplinary team. The position also supports compliance and education related to payors, financial issues, documentation, and patient notices. Candidates with an associate degree in nursing must be actively pursuing a bachelor’s degree in nursing, business, health care administration, or an equivalent field, and complete the bachelor’s degree within three years of hire. UofL Health accepts a Nurse Licensure Compact (NLC) in lieu of a Kentucky nursing license, per the Kentucky Board of Nursing.

Requirements

If holding an associate degree in nursing, actively pursue a bachelor’s degree in nursing, business, health care administration, or an equivalent field.
For candidates with an associate degree in nursing, complete the bachelor’s degree within three years of the date of hire.
Hold a Kentucky nursing license or a Nurse Licensure Compact (NLC) accepted in lieu of a Kentucky nursing license.

Responsibilities

Conduct timely initial admission assessments using clinical indicators and anticipated service needs to determine the appropriate level of hospital care, and validate patient demographics and payor source.
Contribute to ongoing multidisciplinary clinical assessments to support the quality and appropriateness of patient care.
Implement, reassess, and evaluate patient condition and coordinate the plan of care daily.
Develop patient-specific plans of care based on patient needs and discussions with providers and staff, and ensure updated plans are documented in the electronic medical record.
Coordinate patient discharge needs with internal and external providers while protecting patient information.
Complete timely, professional, and appropriate documentation in accordance with the Quality Review Audit process.
Advocate respectfully and confidentially for patient and family needs.
Facilitate communication between patients and the interdisciplinary health care team, help manage unusual or question cases, educate the team about the RN Case Manager role, and remain available as a resource.
Refer cases to the care coordination manager or director, CAO, or medical director when intensity of service or severity of illness criteria are not present and the issue cannot be resolved.
Ensure delivery of the Medicare Important Message and Medicare Outpatient Observation Notice when applicable.
Acknowledge, address, and complete Case Management consults in the electronic medical record for assigned units.
Collaborate with social workers to identify social and financial barriers and community resources, and refer patients with high-risk indicators to social work.
Attend monthly departmental staff communications meetings and serve on committees as needed.
Support professional growth and maintain competency in care management principles through education, professional reading, in-service meetings, and workshops.
Educate physicians, patients, and staff about payors, financial issues, documentation, and potential compliance issues.
Serve as a resource to physicians on clinical management and financial issues, and help promote care delivery efficiencies and reduce or eliminate barriers to effective service.
Comply with company policies, procedures, standards of conduct, and HIPAA privacy and security requirements.
Perform other duties as assigned.