Case Manager RN Per Diem Job Norwalk area,Connecticut USA,Nursing

Weekends and Holidays, 8:30 am-5:00pm

Summary:

The Case Manager RN, working in conjunction with the centralized denial prevention team, partners with the local interdisciplinary care team to facilitate the progression of care for the hospitalized patient. Together with the medical provider, the Case Manager RN collaborates with all members of the care team, focusing on the delivery of efficient, high-quality care. This position ensures the appropriate utilization of clinical resources with a goal of a safe and timely discharge for the patient.

This role navigates health system services to support effective transitions while advising the team on healthcare industry compliance. The Case Manager RN must be adept at driving throughput metrics, clinical effectiveness, and fiscal responsibility.

Responsibilities

Initially screen all patients early in the hospitalization, particularly for patients likely to have post‑acute needs and every 1‑2 days throughout their stay to facilitate care progression to establish an anticipated length of stay and transition planning needs.

Collaborates with the medical team to formulate a treatment plan to include care transitions and promote patient flow.

Completes an initial assessment of all admissions/observation patients to identify barriers that impact the length of stay and discharge planning. The assessment should also identify the needs of the patients, acknowledge current resources available, and anticipate future resources needed to facilitate successful transitions.

Navigates the care delivery system while collaborating with the physician and other clinical departments by ensuring that tests, treatments, consults, and procedures are appropriately indicated and performed timely.

Articulates the plan of care and communicates this plan to other care team members and patient/caregiver. Intervenes to maintain care progression when a deviation in the plan occurs.

Creates and coordinates the overall transition plan of care based on initial assessment and concurrent collaboration with social workers, direct care providers, other hospital departments, external service organizations, agencies and healthcare facilities, community care and navigation services, and the patient and family/caregiver.

Case Management facilitates daily Multi‑Disciplinary Rounds (MDRs) incorporating evidence/best practice milestones in the plan and communicates that plan to the health care team.

Apprises the interdisciplinary team of the estimated length of stay, care progression barriers, and anticipated disposition. Identifies what is needed from the team to facilitate the plan.

Facilitates smooth care transitions by ensuring appropriate clinical follow‑up is arranged and referrals to proper post‑acute providers are initiated.

Communicates the plan effectively with the patient and family/caregiver making certain that they have resources for success post‑discharge. Understands organizational goals for the length of stay and unplanned readmissions.

Proactively interfaces with the payer, where required, verifying coverage/benefits for anticipated discharge needs and obtaining authorization for post‑acute care.

Identifies patients that are readmitted or at high risk for unplanned readmissions and initiates appropriate interventions. Identifies organizational resources within the community and engages those resources as necessary.

Documents avoidable days (if not captured by another Care Transitions Team member), case management assessments, and care plans in a thorough and timely manner, per department policy.

Ensures appropriate care provider documentation to support the patient’s anticipated discharge plan of care. Escalate deviations from the plan to the Physician Advisor as appropriate.

Completes clear and concise documentation of the care plan and communicates this to the interdisciplinary team and the patient/caregiver.

Identifies and communicates any problems or issues affecting patient flow, patient satisfaction, safety, length of stay management, or outcomes to the department director and/or appropriate key stakeholder.

Functions as a resource for governmental and health care industry regulations…