RN CASE Manager: University Hospital; Care Management

RN CASE MANAGER:
University Hospital (Care Management)

The RN Case Manager assesses, develops, implements, coordinates, and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker, and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. The position creates a balance between individual clinical needs and the efficient and cost‑effective utilization of resources while promoting quality outcomes.

• Reports directly to the Manager of Care Management.
• Works closely with the unit‑based MPLAN team to reach unit and organization goals, including length of stay, care transitions, readmissions, and other quality initiatives.
• Collaborates with the interdisciplinary team to develop and implement a comprehensive, integrated discharge plan from the emergency department.
• Recommends and documents patient classification of all admissions utilizing established criterion set.

• Within 24 hours of admission, interview each patient/family for anticipated needs post‑hospitalization.
• Develop day‑to‑day and overall care plans with providers, patients, and nursing staff.
• Lead daily care‑coordination rounds to update plans and facilitate implementation.
• Initiate discharge plans, including early referrals to home‑care, DME, and infusion services.
• Prepare patients/families for discharge, ensuring understanding of follow‑up and resources.
• Maintain standard procedures for routine patient/family conferences with social workers.
• Ensure patient handovers to next level of care and collaborate with Care Navigators, complex‑care case managers, home‑care, and sub‑acute liaisons.
• Support the nursing model of care by collaborating with nursing managers to achieve patient‑ family–centered care goals.
• Facilitate increased discharge volume by noon to improve capacity management.
• Collect avoidable days information and report findings in care‑management software (Allscripts).
• Participate in venues to reduce barriers to discharge.
• Conduct clinical reviews on admission; review every 3 days or as requested by payer.
• Determine patient classification and ensure compliance with observation and billing requirements.
• Communicate with third‑party payers for necessary authorizations.
• Obtain anticipated LOS and ensure all team members are aware.
• Refer defined cases for medical secondary review and share findings with providers.
• Assist Revenue Cycle/HIM with release of adjustments and appeals.
• Review all cases with readmission within 30 days and report findings.
• Identify cost‑reduction opportunities and participate in utilization‑management venues.
• Conduct referrals and consultations with Physician Advisor.
• Actively participate in performance planning and individual development.
• Maintain current knowledge of case management, utilization management, and discharge planning guidelines.

• Engage in the performance‑planning, competency, and individual development processes.
• Keep up‑to‑date knowledge of federal, state, and private insurance guidelines for case and utilization management.

• Knowledge of community resources to coordinate safe discharge from emergency departments.
• Excellent interpersonal, communication, and negotiation skills.
• Ability to work collaboratively with social workers and interdisciplinary team members.
• Strong organizational and time‑management skills.

• Bachelor of Science in Nursing, Associate’s Degree in Nursing, or Nursing Diploma with a Master’s Degree in Nursing.
• Current Michigan Board of Nursing licensure.
• Minimum of three (3) years acute‑care RN experience or 3 years case‑management experience with acute‑care patients.
• One (1) year of successful leadership or management experience in nursing management, case management, or clinical career ladder advancement.

• Two (2) years hospital discharge‑planning experience.
• Master’s degree in nursing or related field.
• Case‑Management certification (e.g., ACM or CCM).
• Proficiency in Inter Qual criteria and Allscripts.
• Experience with quality‑improvement initiatives and home‑care or skilled home‑health services.

• Hours:
  
  40 per week
• Shift: 8:00 a.m. – 4:30 p.m. (day shift) with weekend and holiday commitments.
• Location:
  
  UMH Care Management, Onsite.

• Hourly rate (RSAM Competent RN): $43.10 – $67.03
• Shift differentials:
  Evening $3.00;
  Night $4.00;
  Charge Nurse $1.00.
• Benefits include medical, dental, vision coverage; 2:1 retirement savings match; tuition and certification support; professional development; and more.

The University of Michigan is an equal employment opportunity employer.