RN Case Manager - Weekends

Job Title:

RN Case Manager
- Weekends

Full time

Day/Evening (United States of America)

1906 Belleview Ave SE
- Roanoke CP01 Carilion Medical Center.

R152941 RN Case Manager
- Weekends (Open)

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/family movement through the health care organization. Responsibilities include patient needs assessments upon admission and at regular intervals, facilitating referrals, providing linkages to health, wellness, and post‑acute care resources, promoting interdisciplinary collaboration, maintaining compliance with federal and state discharge regulations, and incorporating growth and development knowledge appropriate to each age group served.

• 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 regarding progression of care.
• Provides feedback to the health care team verbally and via chart entries regarding the patient’s progress toward expected outcomes or barriers to the plan, and 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 Social Work.
• Documents in the medical record within the appropriate time frame, accurately reflecting the plan of care and interventions, and complies with CMS regulations related to discharge planning documentation.
• Coordinates referrals of post‑acute services such as home health, hospice, and durable medical equipment (DME), directing liaison activities to integrate with the patient and the health care continuum.
• Facilitates appropriate referrals surrounding high‑cost medications for all patients, insured or uninsured, working with other disciplines and support staff to obtain prior authorizations and co‑pay information.
• Ensures 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.
• 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.
• Daily tasks/expectations: participate in unit‑based IDR huddles, coordinate referrals (DME, HH, Hospice), utilize predictive analytic software, complete face‑to‑face assessments, communicate with assigned UR nurse and Social Work partner, reassess patients, document status of…