SAH RN Case Manager EX

Brown Medicine•Los Angeles, CA

4d•$39 - $77•Onsite

About The Position

The RN Case Manager promotes high-quality patient care in the most effective setting while balancing patient and hospital advocacy. The role requires knowledge of third-party payer issues and coordinates care across the continuum, supports safe and timely discharge, monitors resource utilization, and helps manage transitions to appropriate services. The case manager works with patients and families, physicians, nursing staff, therapeutic disciplines, managed care organizations, community agencies, and other reviewers. Brown University Health employees are expected to model the organization's values of Compassion, Accountability, Respect, and Excellence, and demonstrate the Success Factors of instilling trust, valuing differences, focusing on patients and the community, and collaborating. The position includes clinical documentation and assessments, discharge planning, utilization management, coordination of services and resources, quality and cost monitoring, and coverage of case management activities when the assigned case manager is absent. The role also requires culturally respectful communication with patients, families, visitors, and colleagues, including use of interpreters when needed. Other duties may be assigned.

Requirements

Knowledge of disease management.
Bachelor of Nursing degree required; significant case management experience may be considered in lieu of the bachelor's degree.
Current Massachusetts RN license.

Nice To Haves

Three to five years of acute care nursing experience, or one to three years of experience in utilization review and/or discharge planning.

Responsibilities

Coordinate patient care across the continuum and mobilize internal and external resources for assigned cases.
Document the patient care plan, progress, goals, interventions, and interdisciplinary coordination in accordance with department, federal, and state guidelines.
Provide nursing assessments within 24–48 hours of admission when needed, supporting a clinically safe and timely discharge.
Identify care problems and gaps, suggest interventions, expedite interdisciplinary referrals, and ensure diagnostic testing is completed and reported on time.
Participate in patient care conferences and collaborate with medical staff, nursing, and therapeutic disciplines on care plans when covering for a unit case manager.
Follow the plan initiated by the unit case manager or initiate an initial plan of care for newly assigned patients.
Maintain professional working relationships with managed care organizations and external review agencies; respond to calls and provide timely, concise, and accurate patient care information.
Monitor utilization of resources, identify over- or under-utilization, and intervene with physicians and therapeutic disciplines to address barriers affecting length of stay.
Apply severity-of-illness and intensity-of-service criteria according to third-party payer guidelines and identify appropriate levels of care.
Communicate utilization, length-of-stay, and other identified issues to the unit case manager through Allscripts and maintain dialogue with the care team.
Identify complex-management cases and strategies to reduce length of stay and resource consumption; assist physicians with external payer issues when needed.
Coordinate services and resources with patients, families, physicians, and community providers; explain the case management role, expected length of stay, and planned outcomes.
Identify and refer patients who need short-term skilled or long-term chronic care, coordinate transitions, and transfer accountability to the appropriate person or agency at discharge.
Report quality-of-care issues to the Outcomes Manager and participate in data collection, tracking utilization and outlier stays, and identifying aberrant practices.
Collect, organize, and enter data according to QRM quality indicators, quality screens, and case management criteria.
Develop and implement strategies to address patterns or issues with negative quality-cost impacts.
Maintain knowledge of case management, utilization management, and discharge-planning regulations and follow department policies and procedures.
Assume case management activities when the assigned case manager is absent and inform the department secretary of new or exchanged referrals for accurate statistics.
Attend department meetings when available, participate in discussions and issue resolution, and take on new responsibilities as requested.
Communicate respectfully and effectively with culturally diverse internal and external customers, using interpreters when needed.
Perform other duties as assigned.