RN Case Manager - Inpatient - Weekdays

Employment Status

Full time

Day/Evening (United States of America)

1906 Belleview Ave SE
- Roanoke CP01 Carilion Medical Center.

R151590 RN Case Manager
- Inpatient
- Weekdays (Open)

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

$76,689.60 - $

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. The role promotes cost‑effective care by minimizing fragmentation, maximizing coordination, and facilitating patient and family movement through the healthcare organization. Responsibilities include performing patient needs assessments upon admission and at regular intervals, facilitating referrals, supporting interdisciplinary collaboration, and ensuring regulatory compliance in discharge planning.

• Collaborates with Utilization Review Nurse.
• Maintains regular contact with assigned Utilization Review Nurse 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 accurately reflects the patient's condition, co‑morbidities, treatment and procedures that 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.
• Actively participates in Interdisciplinary Team Meetings on assigned units, sharing meaningful and professional knowledge to the team discussion regarding progression of care.
• Provides feedback to the health care team verbally and via chart entries regarding the patient's progress toward reaching expected outcomes or about barriers to the plan. Manages changes to the plan as necessary.
• Maintains 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 throughout the workday.
• Coordinates care and services within the case managed population.
• Performs face‑to‑face assessments of patients/families when appropriate to identify individualized needs in collaboration with SW.
• Complies with CMS regulations related to discharging planning documentation.
• Coordinates referrals of post‑acute services such as home health, hospice, and durable medical equipment (DME).
• Facilitates appropriate referrals surrounding high‑cost medications for all patients, insured or uninsured, and obtains prior authorizations and/or co‑pay information.
• Ensures coordination of care when patients are transferred: acute hospital to acute hospital, and jails/prisons.
• Advocates for the patient and family throughout the entire episode of care.
• Participates in departmental and system performance improvement initiatives.
• Contributes to Carilion Clinic's performance improvement activities by engaging with predictive analytic software.
• Collects and analyzes relevant patient care and fiscal data.
• Analyzes and evaluates the effect of case management on quality outcomes and fiscal parameters.
• Complies with all departmental policies and practices and fosters teamwork and professionalism.

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

Experience: Three years of recent experience in a clinical health care setting with responsibilities reflecting direct management of patient care, including planning, coordination, and delivery of needed services such as education, psychosocial support, discharge planning, and 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:

Must…