RN Case Manager

RN Case Manager

Position: RN Case Manager – Care Management Division – Oregon Health & Science University – Portland, OR

The Care Management department provides major services to assure safe and efficient of patients during acute hospitalization and transition to the next level of care. The goal is to balance individual clinical and psychosocial patient/family needs with efficient, cost‑effective utilization of resources while promoting quality outcomes.

RN case managers assess patients on admission for available family support, insurance resources, and potential discharge planning needs. They engage in daily multidisciplinary rounds Monday through Friday to develop and implement patient discharge plans with input from various disciplines. The RN case manager is responsible for coordinating post‑acute and discharge needs in a timely and cost‑efficient manner. Using established criteria to determine appropriateness of continued hospital stay, RN case managers work with payors on obtaining needed authorizations for ongoing hospitalization and/or identified post‑acute needs.

The RN case manager collaborates with the patient and family, members of the multidisciplinary team, community resources and agencies, and payors to ensure the patient’s progress and level of care is appropriately determined. Intensity of service is dependent on individual patient needs as assessed by the case manager. RN case managers practice robust utilization and resource management.

RN case managers also frequently lead multidisciplinary and family care conferences involving complex care situations. They contribute to meeting OHSU's strategic plan of safe length of stay reduction and reduction in readmission rates.

Case Management is represented on every adult and pediatric unit and in the Emergency department. Each Case Manager has an office with a workstation near the unit they are assigned to. Communication factors:
Case Managers are available by pagers, telephone/voicemail, Microsoft Teams, Epic Secure Chat, and e‑mail.

Case Management is represented on every adult and pediatric unit and the Emergency department.

Communication factors:
Case Managers are available 7 days a week between the hours of 0700‑2300. They are available by pager, telephone, e‑mail, and approved messaging applications.

Admit/ED Nurse Case Manager functions include:

• Assuring accurate patient status and admission order for patients entering via ED, OR, 7 days per week
• Reviewing ED Observation unit patients for meeting observation criteria and completing UR using established criteria
• Rounding with NP in ED OBs by 10am
• Effectively communicating reviews with Patient Placement Office
• Following up in collaboration with unit CM on admission status and completeness of Utilization review on admission
• Performing discharge planning for patients in the Emergency department
• Assessing patients potential to discharge from ED with community care coordination (PCP location, follow up appointments, medication assistance, SNF, long term care, DME, Memory or Foster care)
• Back up for weekend/EVE Case Managers
• Following current data tracking procedures
• Reviewing transfer center patients and advising physicians on acceptance of potential transfers
• Performing Utilization Review for each patient admitted without a review during weekend hours using established medical necessity guidelines
• Reviewing order/classification discrepancies and taking actions to resolve the discrepancy
• Discussing cases with providers and Case Managers as needed, including attending physicians and escalation to the Care Management Physician Advisor when indicated
• Assessing for and tracking potentially avoidable hospital days
• Educating providers regarding documentation requirements that support medical necessity determinations
• Delivering Condition Code 44 notices, Observation notices, and Medicare Important Messages in the absence of sufficient clerical support
• Documenting according to departmental policy
• Leading the effort to assure compliance with CMS and other insurance regulations related to Utilization Review

Evening Shift RN Case Manager functions include:

• Providing…