Rn Case Manager Jobs

About The Position

Requirements

• Bachelor's degree in Nursing
• Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Nice To Haves

• Three (3) years acute care nursing experience.
• One (1) year acute care case management experience preferred.
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) is preferred.
• Knowledge of Medical Necessity Criteria preferred.
• In lieu of the BSN requirement above, a nursing diploma or an Associate degree in Nursing may be considered if the applicant signs a BSN Memorandum of Understanding (MOU) agreeing to enroll in an accredited BSN or MSN program within one year and obtain a BSN or MSN degree within (4) four years of hire date. Further, employees must demonstrate sufficient progress annually toward obtaining an accredited BSN or MSN degree to remain eligible for employment or may be terminated.
• Employees in this title prior to 10/24/2021 are grandfathered into the title and are only required to have an AD N or Nursing Diploma.

Responsibilities

• Partners with attending providers throughout hospitalization to promote effective and efficient utilization of clinical resources, ensuring quality, cost-effective care.
• Anticipates next steps and facilitates communication to maximize care efficiencies for the patient and family.
• Identifies social determinants of health that increase the patient's risk for negative outcomes.
• Ensures clear documentation for the interdisciplinary care team and coordinates post-acute plans with the ambulatory care management team as appropriate.
• Facilitates patient access to resources and relevant services.
• Addresses and resolves system problems impeding diagnostic or treatment progress.
• Proactively identifies, resolves, and documents delays and obstacles on the patient's behalf.
• Drives change by identifying areas where performance improvement is needed.
• Navigates value-based care with expertise and ensures longitudinal plan is patient-focused and aligns with patient and caregiver goals.
• Assesses patients’ and family’s psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness, and ability to cope, based on preliminary risk screening.
• Maintains expert-level knowledge of body systems and expected clinical outcomes for patient disease process.
• Maintains current knowledge of changes in state and federal regulatory requirements related to the provision of care management services in an acute care setting.
• Maintains care management knowledge to provide services in accordance with standards of practice as established by department and management.
• Ensures medical necessity, appropriate level of care, and timely implementation of the plan of care in accordance with the hospital(s) Utilization Review Plan.
• Navigates the team through complex compliance, regulatory, and insurance requirements.
• Coordinates with third-party payors on a regular basis.
• Serves as a resource for patients and families regarding their rights and responsibilities when payment of care is denied or when care is no longer medically necessary, including delivery of regulatory documents from CMS.
• Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system.
• Performs other duties as assigned.