Rn Case Manager Jobs

About The Position

Requirements

• Bachelor's degree in Nursing.
• Three years of acute care nursing experience.
• Licensed to practice as a Registered Nurse in South Carolina.
• In lieu of a BSN, a nursing diploma or Associate degree in Nursing may be considered if the applicant signs a BSN Memorandum of Understanding agreeing to enroll in an accredited BSN or MSN program within one year and obtain a BSN or MSN within four years of hire. Employees must demonstrate sufficient annual progress toward the degree to remain eligible for employment.
• Employees in this title before 10/24/2021 are grandfathered into the title and are only required to have an Associate degree in Nursing or a nursing diploma.

Nice To Haves

• One year of acute care case management experience.
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification.
• Knowledge of Medical Necessity Criteria.

Responsibilities

• Partner with attending providers throughout hospitalization to promote effective and efficient use of clinical resources and quality, cost-effective care.
• Anticipate care needs and facilitate communication to maximize care efficiencies for patients and families.
• Identify social determinants of health associated with negative outcomes, document relevant information for the interdisciplinary team, coordinate post-acute plans with ambulatory care management as appropriate, and facilitate access to resources and services.
• Identify, resolve, and document delays and obstacles impeding diagnostic or treatment progress; identify areas for performance improvement.
• Navigate value-based care and ensure longitudinal plans are patient-focused and aligned with patient and caregiver goals.
• Assess patients’ and families’ psychosocial risk factors, including prior functioning, support systems, reactions to illness, and ability to cope.
• Maintain knowledge of body systems, expected clinical outcomes, regulatory requirements, and care management standards of practice.
• Ensure medical necessity, appropriate level of care, and timely implementation of the plan of care in accordance with the hospital Utilization Review Plan.
• Guide the team through compliance, regulatory, and insurance requirements and coordinate regularly with third-party payors.
• Inform and assist patients and families regarding their rights and responsibilities, including when payment is denied or care is no longer medically necessary; deliver regulatory documents as provided by CMS.
• Advocate for patient and family empowerment, autonomous healthcare decisions, and access to needed services.
• Perform other duties as assigned.