RN - Case Manager

RN - Case Manager

Profession: Registered Nurse

Specialty: Case Management

Duration: 13 Weeks

Shift: Day

Hours per Shift: 8

Experience: 5+ Years of RN Case Management Experience

License: CA RN License

Certifications: BLS

Must-Have: Inpatient Acute Case Management Experience

Description:

Must have discharge planning experience.

Case Manager RN needed for 5/8s every other weekend.

Responsible for care coordination and care transitions planning throughout the acute care patient experience.

This position works in collaboration with the physician, utilization manager, medical social worker, and bedside RN.Assures the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions.

The care management process encompasses communication and facilitates care across the continuum through effective resource coordination.

Goals of this role include achieving optimal health, access to care, and appropriate utilization of resources.

Collaboration occurs with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third-party payers, and community resources.

If assigned to the Emergency Department, the care management process addresses complex clinical and social situations efficiently to avoid unnecessary admissions.

Job Accountabilities:

Conduct patient initial and continued assessments.

Review initial physician admission care plan.

Gather additional medical, psychosocial, and financial information from patient/family interviews and medical records.

Determine moderate or high-risk levels for readmission.

Conduct screenings for ancillary supportive services.

Lead the healthcare team in developing comprehensive, cost-effective care coordination plans.

Identify and refer quality and risk management concerns for patient safety reporting.

Direct and oversee the case management assistants to determine preferences for post-acute care services.

Utilization Management:

Review medical records to ensure patients continue to meet level of care (LOC) requirements.

Work with attending physicians to confirm necessary documentation to support LOC.Expedite transition planning for patients who no longer require acute level of care.

Monitor length of stay (LOS) and outliers requiring additional resources.

Collaborate with financial counselors for delivery of inpatient stay denials.

Ensure delivery of necessary patient information within required timelines.

Participate in patient rounds and collaborate with the interdisciplinary team for timely transitions.

Care Coordination/Care Transitions:

Formulate transition plans after reviewing appropriate care options.

Communicate assessment findings to the healthcare team.

Screen for 30-day readmissions and review previous hospital records.

Proactively identify barriers to care progression and work with the multidisciplinary team to resolve them.

Review and modify plans of care as necessary.

Assess the need for follow-up appointments and communicate them to patients/families before transitions.

Ensure necessary paperwork for post-acute transfers complies with regulatory requirements.

Identify patients with complex psychosocial issues and refer to the healthcare team.

Communicate with financial counselors regarding uninsured and underinsured patients.

Actively participate in ongoing department operations.

Identify new systems, processes, and protocols to improve practices.

Contribute to creating cost-effective practices that ensure the best patient/provider experience.

Communicate effectively with care management colleagues for safe transitions.

Manage all communications related to department operations.

Use effective interpersonal and communication skills to promote customer service.

Develop and maintain positive professional relationships with the healthcare team and community agencies.

Approach all customers with respect regardless of diverse backgrounds.

Participate actively in department operations and accept constructive feedback.

Utilize effective communication skills with colleagues to resolve issues in a timely manner.