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

UC Health•Cincinnati, OH

About The Position

The 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 includes clinical effectiveness, discharge planning, care coordination, and clinical resource management. The Case Manager works with Medical, Nursing, and Ancillary department staff to support quality-based, cost-effective patient outcomes and ensure care is provided in the most appropriate setting. The role includes coordinating safe and timely transitions of care, assessing discharge barriers, collaborating with patients, families, caregivers, physicians, and multidisciplinary teams, and arranging appropriate services and resources. It also includes concurrent utilization review to assess medical necessity, level of care, and resource use; participation in quality improvement and process improvement activities; and ongoing professional development.

Requirements

Registered Nurse qualification from an accredited school of nursing, college, or university.
Current RN license in Ohio.
At least three years of experience in home health, discharge planning, and/or case management.
Current BLS certification from the American Heart Association at the time of hire.

Nice To Haves

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

Responsibilities

Engage in population-appropriate communication and account for patients’ developmental, physical, behavioral, psychological, religious, and cultural needs.
Give patients and families clear treatment instructions and involve family or guardians in assessment, initial treatment, and ongoing care.
Recognize and respond appropriately to signs or symptoms of abuse or neglect, and safely perform treatments, administer medications, or operate equipment.
Collaborate with the healthcare team on plans of care, referrals, and ongoing patient needs, and coordinate communication about the plan with residents and attending physicians.
Review and assess selected cases within one business day of admission and throughout the stay as appropriate to plan timely, appropriate transitions of care.
Conduct brief face-to-face screens for appropriate patients within one business day of admission to identify discharge barriers and document findings in MR Progress Notes.
Work to improve quality and efficiency, reduce treatment delays, manage length of stay, and support patient satisfaction.
Facilitate timely tests and procedures, obtain lab results, and discuss discharge implications with nursing staff and residents as needed.
Evaluate patient responses to pharmacological and therapeutic treatment regimens with the care team.
Collaborate on discharge forms, paperwork, and prescriptions, and identify and resolve actual or potential service delays with relevant parties.
Coordinate patient care conferences based on patient and family needs, and ensure patients and families receive appropriate information and education before transition.
Identify discharge needs, implement a plan of care, and coordinate a safe and timely discharge to home or another level of care.
Arrange skilled home care, medical equipment, supplies, infusions, enteral services, and treatments as needed, and coordinate their timing with discharge.
Collaborate with home care providers regarding benefits and coverage, and advocate, mediate, and negotiate to support patient health and safe transitions.
Provide consultation and training to medical staff and other healthcare professionals on discharge and home care issues; identify service-delivery barriers and develop improvement processes.
Identify and provide or refer patients and families to available resources, and coordinate education regarding the plan of care and healthcare needs.
Help 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 outcomes.
Call patients discharged with home care or durable medical equipment to confirm that aftercare arrangements were successful.
Review assigned patients to ensure admissions, continued stays, and ancillary services are medically necessary and provided in an appropriate setting.
Use the Allscripts/ECIN work list to determine daily work assignments and perform concurrent chart review.
Evaluate initial level of care and patient type to support appropriate use of facility resources, and discuss admission criteria and expected length of stay with the care team.
Work with resident and attending physicians as needed to establish clinical findings supporting SI/IS criteria, length of stay, and patient care guidelines, and ensure appropriate documentation.
Escalate cases to the Clinical Manager when appropriate for review and allocation of resources, including consultation with nursing leadership, hospital administration, and physician leaders.
Support quality initiatives under department leadership and use customer-focused interpersonal skills, problem solving, and critical thinking.
Communicate and resolve conflicts with physicians, healthcare team members, community agencies, clients, and families with differing opinions, values, and religious or cultural perspectives.
Perform other assigned duties, including participating in departmental planning sessions.
Attend appropriate clinical and professional organizations, workshops, and meetings; stay informed about community resources and clinical advancements related to the primary patient population; and learn about roles beyond the immediate area within the department.