Case Manager

Summary

Reports to the Manager or Director of Case Management. Provides coordinated care support to facilitate and expedite patient care services. Participates in daily rounds and collaborates with the clinical healthcare team across the patient care continuum to include preadmission and post‑hospital discharge. The employee is expected to role model the organization’s values of Compassion, Accountability, Respect, and Excellence, and to demonstrate the core Success Factors:
Instill Trust and Value Differences, Patient and Community Focus, and Collaborate.

• Partners with medical staff and other members of the healthcare team in collaboration with the patient/family to facilitate the plan of care for a defined patient population.
• Identifies a high‑risk patient population within the caseload for care management assessment, screening, and targets interventions within one business day of patient admission.
• Participates in daily care rounds to collaborate with members of the patient’s healthcare team and evaluate and facilitate the development and implementation of the discharge planning process.
• Develops the initial patient discharge plan, reviews it with the patient, family members, and interdisciplinary team, and reassesses it daily during collaborative care rounds.
• Proactively builds post‑hospital referrals and sends them to the Transition Care Coordinator to facilitate timely discharge.
• Delivers important message follow‑up notices to all Medicare patients according to CMS regulations.
• Follows CMS and DOH regulations regarding discharge guidelines and patient rights.
• Coordinates length of stay with the physician care team and informs the team of insurance qualifiers that may affect the discharge plan.
• Advocates for the patient and advises them regarding the financial implications of their discharge plan when coordinating care.
• Documents final discharge disposition in progress notes and develops appropriate patient care reports to ensure safe handover when a patient is transferred.
• Provides care plan direction for advancement of a patient care delivery system that supports managed care strategies and reduces readmission risk.
• Acts as a change agent by identifying opportunities to improve patient flow and reduce service delays through problem resolution and follow‑up.
• Participates in departmental and/or interdepartmental quality improvement activities and in the orientation of new staff as requested.
• Maintains an advanced level of knowledge of patient care services, third‑party payer and managed care requirements, and case management through ongoing education and professional affiliations.

• Licensed Registered Nurse in the State of Rhode Island by the Rhode Island Board of Nursing or licensed under the Nurse Licensure Compact.
• Graduate of a School of Nursing with a current license to practice in Rhode Island.
• Minimum of 3 years of clinical experience with recent experience in case management, community case management, patient navigation, or discharge planning strongly preferred.
• Certification in Case Management by a nationally recognized organization required or to be obtained within one year of hire.
• American Heart Association Basic Life Support (BLS) Provider required.
• Strong analytical, interpersonal, and collaborative communication skills to interact daily with a wide and diverse population of health care providers, insurers, patients, and families.
• Proficient in Microsoft Office, email, Outlook calendar, and basic keyboarding skills.

• Demonstrates knowledge of federal and state rules and regulations related to case management.
• Remains current on the latest concepts, techniques, and methods relevant to the nursing specialty.

• Three years of clinical experience with recent focus on case management, community case management, patient navigation, or discharge planning.

General hospital environment with occasional stressful conditions. Must be able to walk through various patient care areas, have visual acuity and finger dexterity for reviewing medical records, navigating automated systems, and typing. Lifting up to 10 lbs. may be necessary.

Responds to individual patient‑care situations demonstrating knowledge and skills acquired through education, certification, and work experience.

$90,417.60 – $

Rhode Island Hospital – 593 Eddy Street Providence, Rhode Island 02903

M‑F 8:00 – 4:30, rotating weekends and holidays

Day

United Nurses And Allied Professional

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.