RN Case Manager

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
The Care Manager - RN provides ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integrating and functions of care management, utilization review and discharge planning. The Care Manager must be highly organized professional with great attention to detail, adaptable to frequent change, and compliant with regulatory and departmental guidelines and policies.

Responsibilities:
• Reviews new admissions and prioritize patients appropriately. Conducts and documents assessment and a plan of care in Electronic Medical Recordkeeping (EMR) system.
• Discusses with appropriate members of the multidisciplinary team when there are barriers to discharge and psychosocial concerns impacting progression of care or readmission risk. Coordinates family meetings, as necessary, to support the progression of care.
• Provides education on community resources, support/educational groups, and any other appropriate resources to patient, family, and care team. Educates and/or coordinates referrals to community resources and post-acute providers as necessary.
• Coordinates with assigned units to provide and receive information on patients’ progression. Alerts care team to concerns that could impact anticipated discharge of the patient and any care that will assist with discharge readiness. Modifies discharge plan based on information shared at the meeting. Assist with identification of the expected discharge date (EDD).
• Collaborates with interdisciplinary care team to problem-solve issues with complex patients and identify trends. Formulates potential solutions with Utilization Manager and Social Worker and continuously monitor cases/follow up on all action items. Proactively identify high risk cases that need to be escalated to the list that are not scheduled for discussion that week. Complete CCM follow-up after the meeting as assigned.
• Maintains a system for monitoring admissions and assures review of continued stays in a timely manner. Monitors all observation patients throughout the day to ensure appropriate progression of care. Interfaces with other hospital departments in matters of review decisions, coding, discharge planning, and UR issues. Serves as a liaison with insurance companies and government agencies to coordinate information needed for approval of hospital procedures/services rendered. Maintains proper documentation for third party payers and other agency requirements.
• Performs admission and continued stay reviews to determine the appropriateness of hospital admission based on approved criteria and standards per the Hospital Utilization Review Plan. Directs delivery of notifications to patients to deliver notifications. Documents activities, events, and information per standards in established software systems

PARDEE

Other information:
Qualifications
Hired applications will be expected to obtain Case Management certification.

Required
• Must be licensed to practice as a Registered Nurse in the state of North Carolina or one of compact states.
• Three years of recent clinical experience in an acute care setting/home health/or long-term care.
• Basic Life Support (BLS) certification
Preferred
• Bachelor's of Science in Nursing (BSN)
• Experience working in a Case Management/Discharge Planning capacity
01.6015.1508

Job Details

Legal Employer: Pardee - HCHC

Entity: Pardee UNC Health Care

Organization Unit: Acute Cs Mgt

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: PARDEEHOSP

Exempt From Overtime: Exempt: Not Applicable