RN CASE MANAGER

Cary Medical Center•Caribou, ME

10d•$35 - $51

About The Position

The RN Case Manager is accountable for organizing the resources necessary to achieve patient outcomes within effective time frames and coordinating the plan of care among members of the health care team. The role requires the ability to practice under minimal supervision and perform the four essential case-management activities: assessment, planning, implementation, and coordination. The Case Manager helps reduce practice variations and enhance patient outcomes. The position is per-diem and non-exempt, with a stated pay range of $34.50–$50.54 per hour. Starting pay depends on factors including experience, education, certifications, internal equity, and market conditions. Depending on departmental staffing needs, the Case Manager may be asked to work nights, weekends, and holidays, and acts as supervisor on weekends and holidays.

Requirements

Active, valid Maine RN license.
Ability to recognize quality-of-care and risk issues and report them to the appropriate individual.
Ability to assess age-specific data in terms of patient needs.
Working knowledge of criteria used to assess levels of care within one month of hire.
Maintain annual nursing competencies.
Acquire ACLS certification within the first year of hire.

Responsibilities

Assess patient needs and develop a comprehensive case-management plan using information from patients, families, caregivers, employers, and health records.
Monitor information relevant to the case-management plan, including concurrent reviews every 1–3 days for service intensity, appropriateness of setting, and discharge planning.
Evaluate the effectiveness of the case-management plan, reassess significant changes in patient status, and revise planning as needed before discharge.
Determine objectives, goals, and actions to meet patient needs, and implement the plan in a timely manner, involving the Physician Advisor as necessary.
Coordinate and integrate resources with patients to meet case-management goals and facilitate Interdisciplinary Team Meetings.
Maintain current working knowledge of insurance reimbursement structures, network provider lists, approval criteria, and appeals processes.
Negotiate service approvals and authorizations, and conduct or facilitate appeals of denials with physicians and/or the Physician Advisor.
Complete work accurately and within acceptable time frames, including during increased workload and stress; use sound judgment when instructions do not address a situation.
Maintain knowledge of work practices, emergency procedures, and personal protective equipment, and complete CDI on inpatient charts.
Coordinate care among health-care team members and serve as a liaison among patients, families, and staff throughout the continuum of care.
Monitor Resource Management protocols and avoidable days.
Ensure identification and reporting of nosocomial infections to the Infection Control Coordinator.
Coordinate department work, set priorities, and reduce non-essential interruptions to meet department and Medical Center needs.
Analyze situations and make timely decisions using planning, research, foresight, and facility goals, involving appropriate parties.
Promote and educate employees about excellent customer service for patients, visitors, physicians, and other employees.
Consult the manager for additional assignments or independently assume responsibility for unassigned tasks.
Participate in Quality Improvement activities and offer suggestions for process improvements; accept and act on constructive criticism.
Adjust personal schedule for workload fluctuations or departmental needs, channel concerns appropriately, and foster teamwork and collaboration.
Participate actively in department meetings and take responsibility for ongoing professional development.
Act as supervisor on weekends and holidays and coordinate bed management with charge nurses.
Comply with local, state, and federal laws and regulations.