RN Case Manager - Inpatient - Weekdays

Job Title: RN Case Manager - Inpatient - Weekdays

Employment Status: Full time

Shift: Day/Evening (United States of America)

Facility: 1906 Belleview Ave SE - Roanoke CP01 Carilion Medical Center.

Requisition Number: R151590 RN Case Manager - Inpatient - Weekdays (Open)

Prim. Monday - Friday, 8am-4:30pm

Sign on bonus and relocation assistance available

The RN Case Manager provides case management for assigned patient populations, utilizing clinical expertise, communication and problem‑solving skills to achieve optimal clinical and resource outcomes. They promote cost‑effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization. They perform patient needs assessments upon admission and at regular intervals, facilitate referrals, and provide linkages to health, wellness, and post‑acute care resources across the continuum.

They promote interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan, and they ensure appropriate length of stay and resource management for care transitions. They comply with all federal and state regulations surrounding the discharge process and incorporate knowledge of growth and development appropriate to the age group served into the care plan.

• Collaborate with Utilization Review Nurse and maintain regular contact throughout the day.
• Use Inter Qual software to support accurate patient statuses according to ongoing medical necessity.
• Aid in the delivery of regulatory letters and patient notices related to insurance coverage/non‑coverage, using support staff as appropriate.
• Ensure documentation accurately reflects the patient's condition, comorbidities, treatment and procedures that support the most appropriate admission status and DRG assignment.
• Communicate with patients/families to ensure understanding of financial implications of discharge plans.
• Facilitate an interdisciplinary approach to patient care.
• Actively participate in Interdisciplinary Team Meetings on assigned units, sharing meaningful and professional knowledge regarding the progression of care.
• Provide feedback to the healthcare team verbally and via chart entries regarding the patient's progress toward expected outcomes or barriers to the plan, and manage changes to the plan as necessary.
• Maintain effective communications with all disciplines to promote timely and appropriate discharges.
• Daily communication with Social Work and Utilization Review: includes case reviews, morning touchpoints, and ongoing communication throughout the workday.
• Coordinate care and services within the case managed population.
• Perform face‑to‑face assessments of patients/families when appropriate to identify individualized needs in collaboration with Social Work.
• Complete documentation in the medical record within the appropriate time frame, accurately reflecting the plan of care and interventions, and comply with CMS regulations related to discharge planning documentation.
• Coordinate referrals for post‑acute services such as home health, hospice, and durable medical equipment, and direct liaison activities to integrate the patient into the health care continuum.
• Facilitate appropriate referrals surrounding high‑cost medications for all patients, insured or uninsured, and obtain prior authorizations and/or co‑pay information to ensure medication needs are met for discharge.
• Ensure coordination of care when patients are transferred: acute hospital to acute hospital, and jails/prisons, communicating with outside nursing or case management staff as appropriate for smooth transition.
• Advocate for the patient and family throughout the entire episode of care.
• Participate in departmental and system performance improvement initiatives.
• Contribute to Carilion Clinic's performance improvement activities by engaging with predictive analytic software.
• Collect and analyze relevant patient care and fiscal data, and evaluate the effect of case management on quality outcomes and fiscal parameters.
• Comply with all departmental policies and practices and foster teamwork and professionalism.

• Participate in…