RN Case Manager, UofL Hospital

UofL Health•Louisville, KY

2d•Onsite

About The Position

The RN Case Manager promotes optimal health care outcomes in accordance with UofL Health policies, procedures, applicable laws and contracts, and the organization’s philosophy, mission, vision, and values. The role supports appropriate use of facilities and services, serves as a resource to physicians, nurses, and ancillary staff, conducts admission assessments, identifies patients who may not meet criteria for their current level of care, and takes action to help ensure the most appropriate care setting. The RN Case Manager participates in daily rapid rounds and coordinates care and discharge planning with the interdisciplinary health care team. The position uses nursing and management processes to guide decisions, maintains confidentiality, and supports organizational goals by providing information to divisions and departments. Under the direction of the Manager or Director of Care Coordination or the CNO, the RN Case Manager supports the Care Coordination Department. The role assesses patients’ clinical indicators and anticipated service needs, validates demographics and payor information, and contributes to ongoing multidisciplinary assessments. It develops and documents individualized plans of care, coordinates discharge needs with internal and external providers, and provides timely, appropriate documentation. The Case Manager advocates for patients and families, facilitates communication among patients and the interdisciplinary team, and provides education and consultation on care coordination, payors, financial matters, documentation, and potential compliance issues. The position also collaborates with social workers to address social and financial barriers and identify community resources, participates in departmental meetings and committees as needed, and maintains professional competency in care management. The RN Case Manager complies with company policies and HIPAA privacy and security requirements and performs other duties as assigned. An associate degree in nursing is acceptable if the employee is actively pursuing a qualifying bachelor’s degree, which must be completed within three years of hire.

Requirements

Registered Nurse qualification and applicable nursing licensure; UofL Health accepts a Nurse Licensure Compact from the NCSBN in lieu of a Kentucky nursing license, per the KBN.
A bachelor’s degree in nursing, business, health care administration, or equivalent is required.
An applicant with an associate degree in nursing must be actively pursuing a qualifying bachelor’s degree and complete it within three years of hire.

Responsibilities

Conduct timely initial admission assessments based on clinical indicators and anticipated service needs to support appropriate levels of hospital care.
Validate patient demographics and payor source.
Contribute to ongoing multidisciplinary clinical assessments to support the quality and appropriateness of patient care.
Implement, reassess, and evaluate patient condition and coordinate the plan of care daily.
Develop patient-specific plans of care using individual needs, discussions with providers and staff, and information in the electronic medical record.
Ensure the updated plan of care is documented in the electronic medical record.
Coordinate patient discharge needs with necessary internal and external providers while protecting patient information.
Complete timely, professional, and appropriate documentation as reflected in the Quality Review Audit process.
Advocate for patient and family needs in a respectful, non-judgmental, and confidential manner.
Facilitate communication and coordination between patients and the interdisciplinary health care team in unusual or questioned cases.
Educate the health care team about the RN Case Manager role and remain accessible as a resource.
Refer cases to the care coordination manager or director, CAO, or medical director when intensity of service or severity of illness is not present and the issue cannot be resolved.
Ensure delivery of the Medicare Important Message and Medicare Outpatient Observation Notice, where applicable.
Acknowledge, address, and complete Case Management consults in the electronic medical record for assigned units.
Work collaboratively with social workers to identify social and financial barriers and community resources.
Refer patients with high-risk indicators to a social worker.
Attend monthly departmental staff communications meetings and participate in committees as needed.
Maintain professional growth and competency in care management principles through education and other professional development activities.
Educate physicians, patients, and staff about payors, financial issues, documentation, and potential compliance issues.
Serve as a resource to physicians on clinical management and financial issues and assist providers in improving care delivery efficiencies and reducing barriers to effective service.
Comply with company policies, procedures, standards of conduct, and HIPAA privacy and security requirements.
Perform other duties as assigned.