Care Manager Jobs

About The Position

Requirements

• State licensure as a Registered Nurse (RN).
• Bachelor’s degree in nursing from an accredited educational institution, or active pursuit of the degree with completion within five years of accepting the position.
• Three years of acute hospital care experience.

Nice To Haves

• Experience in utilization management or case management, critical care, or patient outcomes/quality management.
• Case management certification (ACM or CCM).
• Basic Life Support (BLS) certification as a Healthcare Provider from the American Heart Association, American Red Cross, or equivalent through the Military Training Network (MTN).

Responsibilities

• Complete initial care coordination assessments within 24 hours of admission, as well as assessments for readmission and transition planning.
• Collaborate with social workers and other disciplines to ensure safe, appropriate, and timely transitions to the next level of care, considering available patient resources.
• Assess patient and family needs, identify barriers to discharge, and formulate discharge plans.
• Identify unsigned level-of-care orders, communicate with the utilization management nurse, and obtain orders from providers.
• Review current DRG and length-of-stay information in Cerner to assess discharge planning needs with providers, and identify the family member serving as the point of contact.
• Assess readmission risk for specified patient populations and initiate assigned interventions to support successful transitions across the care continuum.
• Coordinate discharge planning and referrals to social services, ancillary departments, outpatient case management, durable medical equipment, post-acute placement, and other outside agencies in accordance with standard operating procedures.
• Serve as a liaison and communicate daily with physicians, patients, families, nursing, and other healthcare team members.
• Participate in clinical case reviews and interdisciplinary rounds.
• Document assessments, plans, interventions, barriers, and reassessments in the EMR; manage the anticipated discharge date and ensure pertinent information is transferred to post-acute agencies.
• Identify barriers early and develop plans with patients, families, healthcare team members, payers, and community resources.
• Identify and report avoidable days, variances, and service delays from the established plan of care to leadership.
• Represent the integrated care management department on teams, performance-outcomes committees, and projects.
• Ensure a PCP follow-up appointment is made before discharge.
• Follow policies and procedures to maintain effective operations.
• Perform other related duties as required and directed.