RN Case Manager - Medical Pod

Job Title

RN Case Manager
- Medical Pod

Employment Status: Full time

Shift: Day/Evening (United States of America)

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

Requisition Number: R161364 RN Case Manager
- Medical Pod (Open)

• Provide case management for assigned patient populations using clinical expertise, communication, and problem-solving skills to achieve optimal clinical and resource outcomes.
• Promote cost-effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization.
• Perform patient needs assessments upon admission and at regular intervals; facilitate referrals and linkages to health, wellness, and post-acute care resources across the health care continuum.
• Promote interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan; promote appropriate length of stay, resource management, and care transitions to the next level of care.
• Comply with all federal and state regulations surrounding the discharge process and incorporate growth and development considerations appropriate to the patient s age into the plan of care.

• Collaborates with Utilization Review Nurse and maintains regular contact throughout the day.
• Uses Inter Qual software to support accurate patient statuses according to ongoing medical necessity.
• Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non-coverage, using support staff as appropriate.
• Ensures documentation reflects the patient s condition, co-morbidities, treatment, and procedures to support the most appropriate admission status and DRG assignment.
• Communicates with patients/families to ensure understanding of financial implications of discharge plans.
• Facilitates an interdisciplinary approach to patient care and participates in Interdisciplinary Team Meetings on assigned units.
• Provides feedback to the health care team regarding patient progress toward outcomes or barriers, and manages changes to the plan as necessary.
• Maintains effective communication with all disciplines to promote timely and appropriate discharges; daily communication with Social Work and Utilization Review.
• Coordinates care and services within the case managed population; performs face-to-face assessments when appropriate to identify individualized needs in collaboration with Social Work.
• Documents in the medical record in the appropriate time frame and ensures compliance with CMS discharge planning documentation.
• Coordinates referrals of post-acute services (home health, hospice, DME) and integrates with the patient and health care continuum.
• Facilitates referrals surrounding high-cost medications and works with disciplines to obtain prior authorizations and/or co-pay information.
• Ensures coordination of care during transfers (e.g., hospital-to-hospital, transitions to jail/prisons) and communicates with outside staff as appropriate.
• Advocates for the patient and family throughout the care episode; participates in departmental and system performance improvement initiatives.
• Contributes to performance improvement activities by engaging with predictive analytics; collects and analyzes relevant patient care and fiscal data.
• Maintains compliance with departmental policies and fosters teamwork and professionalism.

Education: Registered Nurse. Bachelor s degree required. 5 years of RN hospital experience may be considered in lieu of a bachelor s degree.

Experience: Three years of recent clinical health care experience with responsibilities including planning, coordination, and delivery of services (education, psychosocial support, discharge planning, utilization management). Supervisory or leadership experience is preferred.

Licensure, certification, and/or registration: Current licensure in Virginia as a Registered Nurse.

Life Support: AHA BLS-HCP required within 6 months of hire.

Other

Minimum Qualifications:

Demonstrated knowledge and competency in orientation completion, interpersonal and written communication, integrity, teamwork, customer-focused service, computer…