RN-Case Manager

Ohio County Healthcare•Hartford, KY

2d•Onsite

About The Position

The RN Case Manager will provide utilization review, discharge planning, and care coordination for all levels of patient care in the facility. This role involves admission and continued stay reviews for federal and non-federal patients, application of Condition Code 44 per CMS guidelines, and demonstrating knowledge of various care levels including Acute/Inpatient, Observation, Outpatient Surgery Observation, Swing Bed, Critical Care, and IVT. The position requires effective critical thinking and problem-solving skills, maintaining required documentation, identifying potential abuse and neglect, and understanding relevant regulatory standards. The RN Case Manager will communicate effectively with staff, physicians, patients, families, visitors, and community agencies, perform admission assessments, and initiate discharge planning. They will also assess Private Pay patients, assist with resource navigation, and maintain compliance with MOON notices and Important Message from Medicare per CMS guidelines. Understanding of the Medical Necessity precertification process for outpatient infusion and injection patients is also required. The role involves maintaining strong working relationships with Community Health, Welfare, and Social agencies, participating in continuing education, maintaining a current RN license in Kentucky, and ensuring proper and timely documentation in patient medical records. The RN Case Manager serves as a liaison between Ohio County Healthcare and community agencies for continuity of care post-discharge, maintains confidentiality, responds promptly to referrals, attends meetings, observes dress code, ensures patient safety, schedules and facilitates Swing Bed Care Conferences, and participates in New Employee Orientation regarding abuse and neglect. Actions should align with Ohio County Healthcare’s purpose, vision, and values, and adhere to its legal and compliance program. Early identification and notification of Network for Hope, understanding of roles in emergency situations, and familiarity with Policy Tech, OCH Common Drive, and Interpreting Services are also expected. Involvement in the emergency department to facilitate admissions, discharges, and transfers, and assistance with reporting data are also part of the role. The position may require participation in a QI team.

Requirements

Associate of Science in Nursing (RN)
BLS certification or obtains within six months of hire.
Minimum high school diploma or equivalent required for all positions (may be allowed to sign a GED agreement to obtain within 6 months).

Nice To Haves

Bachelor of Science in Nursing (BSN)
ACLS and PALS provider strongly encouraged.

Responsibilities

Provide utilization review, discharge planning, and care coordination for all levels of patient care.
Conduct admission reviews for federal and non-federal patients utilizing approved criteria.
Conduct continued stay reviews for federal and non-federal patients utilizing approved criteria.
Apply Condition Code 44 per CMS guidelines.
Demonstrate knowledge of various levels of care offered in the facility (Acute/Inpatient, Observation, Outpatient Surgery Observation, Swing Bed, Critical Care, IVT).
Demonstrate effective critical thinking and problem-solving skills with difficult patient situations.
Maintain all required documentation and retention of records.
Identify potential abuse and neglect and comply with reporting standards.
Demonstrate knowledge of regulatory standards that apply to Case Management practice.
Communicate effectively with staff, physicians, patients, families, visitors, and community agencies.
Perform admission assessments and initiate discharge planning at the point of assessment.
Perform risk assessment for potential environmental hazards to patients.
Assess all Private Pay patients and assist with resource navigation.
Maintain compliance with the MOON notice per CMS guidelines.
Maintain compliance with the Important Message from Medicare per CMS guidelines.
Understand the Medical necessity precertification process for outpatient infusion and injection patients.
Maintain strong working relationships with Community Health, Welfare and Social agencies.
Participate in opportunities for continuing education and professional self-development.
Maintain a current license in the state of Kentucky.
Assure proper and timely documentation in patient medical records.
Serve as a liaison between Ohio County Healthcare and community agencies on behalf of the patient.
Maintain confidentiality in all patient records and interactions.
Respond promptly to all referrals.
Attend regularly scheduled meetings.
Observe personal hygiene and dress code.
Ensure patient safety during the course of performing all duties.
Schedule and notify all disciplines, patients, and their families of Swing Bed Care Conferences.
Facilitate and document all Swing Bed Care Conferences.
Participate in New Employee Orientation to educate on abuse and neglect.
Ensure actions are consistent with Ohio County Healthcare’s purpose, vision, and values.
Adhere to Ohio County Healthcare’s legal and compliance program.
Provide early identification and notification of Network for Hope if applicable.
Demonstrate understanding of role in emergency situations in the facility.
Demonstrate understanding of Policy Tech and OCH Common Drive.
Demonstrate understanding of Interpreting Services.
May be requested to be a member of a QI team.
Involvement in the emergency department to help facilitate appropriate admission, discharges, and transfers.
Assistance with reporting data as applicable.