RN-Case Manager-Milford Campus

Yale New Haven Health•Milford, CT

10h

About The Position

The RN Case Manager is responsible and accountable for ensuring high-value patient care that is coordinated, efficient, and aligned with institutional clinical and financial objectives. Working with the healthcare team, the Case Manager uses evidence-based practice to support reliable patient outcomes and appropriate use of resources within designated fiscal time frames. The role participates in evaluating practice patterns and improving patient care and operational efficiency, identifies trends and barriers to care, and works with the multidisciplinary team to resolve them. The Case Manager coordinates care across the continuum, including linking inpatient care with outpatient services and case management. The role supports appropriate admissions, treatment, continued stays, and discharge planning; helps address denials and Medicare notices of non-coverage; coordinates referrals and community resources; and advocates for patients and families. The position also works with nursing and unit leadership to involve clinical nurses in assessment and discharge planning.

Requirements

Minimum of a baccalaureate degree in a clinically related field.
Registered Nurse (R.N.) qualification.
At least three years of relevant clinical experience.
Active RN licensure in Connecticut.
Recent appropriate nursing experience and theoretical knowledge of the nursing process, case management, and continuity of care.
Advanced communication and interpersonal skills with internal and external customers at all levels.
Ability to obtain and interpret information appropriate to patient needs and age.
Advanced assessment and teaching skills.
Leadership skills in planning and managing patient care, acquired through more than three years of clinical nursing experience in an acute care hospital.
Knowledge of computer software and hardware applications and basic knowledge of statistics.

Nice To Haves

Utilization management experience.
Case management experience.

Responsibilities

Coordinate and ensure implementation of the plan of care as part of the interdisciplinary healthcare team, using case management principles.
Establish a system to coordinate patient care across the continuum, linking inpatient care with outpatient care, services, and case management.
Optimize hospital systems that affect quality and length of stay.
Identify and monitor compliance with documentation of variances from established clinical pathway or treatment plan parameters.
Use available information to ensure patients meet clinical needs for admission, treatment, and discharge, and initiate appropriate follow-through with the healthcare team.
Assist clinicians in documenting the appropriateness of admissions and continued stays.
Manage Medicare notices of non-coverage and help provide appropriate documentation to appeal inappropriate denials.
Ensure an appropriate discharge plan is developed and implemented with the healthcare team, including identifying service, treatment, and funding options.
Ensure discharge plans provide continuity of care with appropriate outpatient physicians and needed services.
Contact appropriate outside agencies and initiate and follow through on necessary referrals.
Link patients and families with institutional or community resources, advocate for scarce resources, and develop resources where service-continuum gaps exist.
Work collaboratively with PSM and unit leadership to involve clinical nurses in assessment and planning for discharge to a facility.
Act as a patient advocate with other members of the healthcare team.
Remain aware of ethical and legal issues concerning patient care and work to reduce risk.