Case Manager, RN

Case Management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost‑effective outcomes. Case Managers are recognized experts and vital participants in the care coordination team who empower people to understand and access quality, safe, and efficient health care services.

As part of the Case Management Team, the RN Case Manager applies clinical expertise and medical appropriateness criteria to resource utilization and discharge planning. RN Case Managers act as a liaison between patients, their families, physicians and allied health care providers.

• Conduct an assessment of the patient’s health, physical, functional, behavioral, psychological, and social needs.
• Identifies patient discharge needs by establishing a personal rapport with patients and their families.
• Collaborate with physicians/providers and multidisciplinary team members.
• Educate patients, their families/caregivers, members of the interdisciplinary team about treatment options, health insurance benefits, psychosocial and financial concerns in order to make timely and informed care‑related decisions.
• Communicate on an ongoing basis with the patient, their family, health care professionals, support service providers the case management plan of care.
• Coordinate care interventions, referrals to specialty providers, and community‑based support services, consults, and resources across involved health providers and care settings.
• Provide emotional, psychological and spiritual support to patients and families.
• Advocate for the patient and the payer to facilitate positive outcomes for the patient, the payer, and our organization. However, when a conflict arises, the needs of the patient must be the number one priority.
• Accurately document and submit medical records in a timely manner.
• Maintains patient confidence and protects operations by keeping information confidential.
• Maintains a cooperative relationship among health care teams by communicating information and participating in team problem‑solving methods.
• Maintain current knowledge of local resources and relevant medical research to prove best possible recommendations to patient.
• Continually evaluate the value and effectiveness of case management plans of care, resource allocation, and service provision while applying outcome measures reflective of organizational policies and expectations, accreditation standards, and regulatory requirements.
• Assist in providing utilization management services by using established guidelines to identify the status and admission necessity on each patient, reviewing the continued medical necessity of hospitalization, following up on denials of third‑party payers, and facilitating appeals and peer to peers when needed.
• Administer and provide explanation to the patient when Condition Code 44 letters are necessary.
• Ensures compliance with Conditions of Participation (CoP) discharge planning.
• Regular attendance and punctuality for scheduled shifts.
• Appropriately adapts assessment, treatment, and/or care methods to accommodate the physical, cultural, age‑specific, and other developmental needs of each person served.
• Maintains professional and technical knowledge through continuing education opportunities including internal and external educational offerings.
• Per DRH policy, all required conditions of employment must be met and maintained including required vaccinations.
• This position requires respirator and fit testing. Required testing will be performed on all team members at risk for exposure to airborne infectious diseases, droplet producing procedures, or any caustic chemicals.
• Must adhere to, and promote, safety protocols at all times.
• Implement DRH Standards of Behavior and exhibit behaviors consistent with DRH core values.
• Performs other related duties as assigned.

Minimum Qualifications: Communication skills including fluency in oral and written English. Basic computer skills…