RN Case Manager - Case Management

Health First Careers•Melbourne, FL

About The Position

The RN Case Manager provides quality, safe, customer-focused care and stewardship through advanced clinical skills in patient assessment, planning, intervention, and evaluation. The role works in accordance with Federal Conditions of Participation, Florida regulations, and The Joint Commission accreditation standards. In collaboration with the interdisciplinary team, patients, families, and support personnel, the RN Case Manager promotes optimal clinical outcomes through effective resource utilization and discharge planning for hospital admissions. The position initiates care transitions upon admission, develops and revises individualized discharge plans, identifies patients at risk, supports appropriate and cost-effective care, and addresses barriers to timely discharge. The RN Case Manager also supports compliance with applicable requirements, obtains authorizations as needed, communicates with care-team members, and promotes patient rights and informed decision-making.

Requirements

Associate Degree in Nursing.
Current, valid State of Florida RN license or endorsement.
Current American Heart Association Basic Life Support Healthcare Provider Completion Card upon hire and maintained thereafter.
At least three years of clinical experience in an acute care hospital.
Strong analytical, data management, and computer skills.
Excellent interpersonal communication and negotiation skills.
Demonstrated critical thinking in resolving or escalating barriers.
Ability to work autonomously and prioritize multiple tasks and role components.
Ability to exercise sound judgment when interacting with physicians, payers, patients, and their families.
Flexibility to meet needs in sometimes high-demand and stressful situations.

Nice To Haves

BSN or bachelor's degree in a related field.
CCM or ACM certification.
Case Management experience in an acute care hospital.
Knowledge of care transitions, utilization management, case management, performance improvement, and managed care reimbursement.
Comprehensive knowledge of post-acute community resources across the continuum of care.

Responsibilities

Initiate care transitions at admission and develop or revise individualized discharge plans based on assessment, reassessment, and response to treatment.
Manage length of stay, promote efficient resource utilization, and plan for safe discharge.
Identify at-risk populations using approved screening tools and follow established referral processes to support safe transitions and prevent readmission.
Practice autonomously and in accordance with evidence-based standards.
Serve as a case management resource for compliance with Medicare IM letters, 3008, 1823 PASSR, and DCF mandatory legal reporting requirements.
Collaborate with the Utilization Department, Physician Advisors, Hospitalists, Emergency and other physicians to support appropriate, cost-effective care and patient outcomes.
Identify and resolve or escalate delays and obstacles to discharge.
Identify reimbursement factors affecting post-hospital provider selection and obtain authorizations directly or in collaboration with payer case managers.
Evaluate the effectiveness of the patient's daily plan and involve the patient and family in developing plan goals.
Maintain active communication with physicians, nursing, physician advisors, and other interdisciplinary care-team members to support timely, appropriate resource management and patient transitions.
Support patient rights, informed consents, and advanced directives.
Initiate referrals to the ethics committee, clinical social worker, risk management, or legal services when appropriate.