RN Acute Case Manager - System Care Management

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Job Description

Up To $25,000 Sign On Bonus For Qualified RNs!

Position Summary:

The Acute Case Manager utilizes industry accepted processes for achieving optimal patient, clinical, and operational outcomes timely, coordinated, and in cost effective manners. The Acute Case Manager has the responsibility, accountability, and authority for coordinating the medical management of hospital patients, using outcomes-based approaches. The Acute Case Manager supports the healthcare team in assessing, planning, and facilitating individualized continuum of care plan for patients, based on assessed needs and available resources.

The Acute Case Manager monitors clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal and external offices, payors, and providers. The Acute Case Manager collaborates cooperatively with the patient and members of the interdisciplinary health care team. The Acute Case Manager takes a proactive approach to ensuring the integration of both clinical and operational outcomes through analysis of clinical and financial data, including length of stay and DRG profiling.

Job Description

Up To $25,000 Sign On Bonus For Qualified RNs!

Position Summary:

The Acute Case Manager utilizes industry accepted processes for achieving optimal patient, clinical, and operational outcomes timely, coordinated, and in cost effective manners. The Acute Case Manager has the responsibility, accountability, and authority for coordinating the medical management of hospital patients, using outcomes-based approaches. The Acute Case Manager supports the healthcare team in assessing, planning, and facilitating individualized continuum of care plan for patients, based on assessed needs and available resources.

The Acute Case Manager monitors clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal and external offices, payors, and providers. The Acute Case Manager collaborates cooperatively with the patient and members of the interdisciplinary health care team. The Acute Case Manager takes a proactive approach to ensuring the integration of both clinical and operational outcomes through analysis of clinical and financial data, including length of stay and DRG profiling.

Education, License & Cert:

RN Bachelor of Science degree in Nursing (BSN) or, a Bachelor of Arts (BA) degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to pursue a BSN or BA degree will be considered. Must obtain BSN within two (2) years of hire. Individual consideration may be given to a registered nurse, with significant clinical experience, who holds a bachelor’s degree in a related field.

Experience:

BSN or BA with a minimum of five (5) years relevant experience who demonstrates leadership and autonomy in nursing practice. a) Utilize critical thinking skills to create and or develop a clinical program or position and b) Demonstrated leadership skills for a licensed degree exception, there must be a significant depth of clinical experience: five (5) years of experience in an acute care setting with strong care management, utilization review, and payer knowledge.

A Case Management certification or obtaining a Case Management certification within one (1) year of eligibility is encouraged.

Essential Functions:

• The Acute Case Manager collaborates to support that the right care is provided to patients in the right setting with a broad spectrum of health and community providers.
• Works closely with the Medical Director and other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria.
• Educates the physician and other healthcare team members regarding the coordination of care processes of the patient across the continuum of care.
• Entity specific acute case manager may need to participate in an on‐call system to ensure 24‐hour accessibility and accountability to meet patient needs.
• Serves as patient advocate in representing the patient’s best interests to the providers.
• Procures insurance authorizations where indicated to ensure appropriate, cost effective care.
• Acts as an institutional advocate by managing care in a cost-effective manner and communicating with third party payers.
• Coordinates medical management through ongoing…