Case Manager RN

Position Name: Case Management

Available

Shifts:

• Evening shift: 12:00 PM – 8:30 PM – we can accommodate 11:00 AM – 7:30 PM if need be – Monday – Friday/No Weekends

Side Note*
The rotating weekend requirement is only 2 weekend days per month. It could be one day on two separate weekends

We offer comprehensive cardiovascular care, oncology, orthopedics, and neurosciences. We offer minimally-invasive laparoscopic and robotic surgery, weight loss surgery and treatment. Other services that we provide include women’s health and wound therapy. We are fully accredited by the Joint Commission and certified as a Comprehensive Stroke Center. Our hospital has an Accredited Chest Pain Center by ACC (American College of Cardiology) and is designated as a Blue Distinction Center for Spine Surgery and Bariatric Surgery.

We are committed to patient safety and quality of care. We have received the highest scores available in recognition of this commitment.

We are seeking a dynamic Case Management RN to join our team. The RN Case Manager facilitates the interdisciplinary plan of care with a focus on evaluating the appropriateness of medical necessity, admission status, level of care, and discharge planning. Coordinates activities that promote quality outcomes and patient throughput. Identifies potential barriers to patient throughput and quality outcomes and facilitates appropriate discharge plans

• Conducts initial and ongoing assessment of each individual patient with respect to clinical condition, level of care, and plan of care.
• Reviews admission, pre-op orders for all components necessary for preadmission, admission process.
• Assist the physician offices in obtaining necessary assessments prior to surgery, procedures, and/or admission.
• Includes patient and family in care facilitation and education activities.
• Assist in the development and implementation of critical pathways.
• Utilizes computer support and physician advisor to determine potential outliers (length of stay and changes in condition) in continued hospital stay.
• Communicates the benefits and changes in the various benefit plans, both in the terms of health management and financial implications to physicians, , and patients and families as appropriate.
• Assists in management of payor denials; issues hospital-initiated notices of non-coverage (HINN’s)
• Distinguishes between the levels of care available and interacts with the various benefit plans and their delivery systems to coordinate this care across the continuum.
• Defines desired clinical outcomes, sets target dates, and establishes a plan for required services and care, addressing all needs (i.e., physical, psycho-social, financial).
• Participates in IDT rounds,
• Conducts utilization review, evaluates clinical information, and communicates findings to physicians and payors on a timely basis in accordance with the NFRMC Utilization Review Plan and managed care contractual agreements.
• Submits clinical information to insurance companies to ensure all days are authorized and notifies director of continued stay denials.
• Applies decision support criteria (e.g. Interqual) appropriately.
• Maintains accurate, up-to-date documentation in MIDAS.
• Is cross-trained to function in any of the assigned Case Manager areas.
• Promotes close alignment with medical and ancillary staff to facilitate appropriate patient care delivery, including alternative level of care opportunities.
• Completes required documentation for transfer to next level of care. Coordinates with physician for optimal information related throughout the continuum.
• Assists with patient/family/significant other’s learning needs, abilities and readiness to learn. Identifies barriers to learning, such as language or culture. Integrates this information into the patient’s plan of care.
• Identifies and documents patient/family/SO’s education needs in collaboration with other disciplines and implements an on-going education relevant to these needs.
• Documents patient teaching on appropriate teaching tool for each teaching episode.
• Ensures patient/family/SO understand discharge instructions

• Looking for 3 years of…