RN Case Manager - ED Observation Unit Weekends

RN Case Manager – ED Observation Unit – Full time – Weekends

Employment Status: Full time

Shift: Weekends Only (United States of America)

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

The RN Case Manager provides case management for assigned patient populations, using clinical expertise, communication and problem‑solving skills to achieve optimal outcomes. The role promotes cost‑effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization. It also performs needs assessments upon admission and at regular intervals, facilitates referrals and provides linkages to health, wellness and post‑acute resources, and promotes interdisciplinary collaboration to progress care plans and discharge plans.

• 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 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. CM will review assigned census beginning each day with their SW partner to determine patient statuses and needs for the day.
• Documentation in the medical record is completed in the appropriate time frame, accurately reflecting the plan of care and CM interventions. Complies with CMS regulations related to discharging planning documentation.
• Coordinates referrals of post‑acute services such as home health (HH), hospice, and durable medical equipment (DME). Directs liaison activities to appropriately integrate with the patient and into the health care continuum.
• Facilitates appropriate referrals surrounding high‑cost medications for all patients, insured or uninsured. Works with other disciplines along with support staff to obtain prior authorizations and/or co‑pay information to ensure medication needs are met for discharge and do not create a barrier.
• Ensures coordination of care when patients are transferred: acute hospital to acute hospital, and jails/prisons. Communicates with outside nursing or case management staff as appropriate for smooth transition.
• 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.
• Summary List of Daily Tasks / Expectations of the Nurse Case Manager Role
• Participate in Unit‑based IDR morning and afternoon huddles.
• Coordinate referrals for DME, HH, Hospice.
• Utilize predictive analytic software…