RN Case Manager - Medical Pod

Responsibilities

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

Promotes interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan. Promotes appropriate length of stay, resource management, and care transitions to the next level of care. Must comply with all federal and state regulations surrounding the discharge process. Must possess knowledge of growth and development appropriate to age group served and incorporate plan to meet needs into plan of care.

Collaborates with Utilization Review Nurse, maintains regular contact with the assigned Utilization Review Nurse throughout the day, uses Inter Qual software to support accurate patient statuses, aids in the delivery of regulatory letters and patient notices, ensures documentation accurately reflects the patient’s condition, 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, manages changes to the plan as necessary, maintains effective communications with all disciplines to promote timely and appropriate discharges, coordinates care and services within the case managed population, performs face‑to‑face assessments of patients/families when appropriate, monitors census with the SW partner to determine patient statuses and needs, 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), facilitates appropriate referrals surrounding high‑cost medications for all patients, obtains prior authorizations and/or co‑pay information, ensures coordination of care when patients are transferred, advocates for the patient and family throughout the entire episode of care, and participates in departmental and system performance improvement initiatives.

• Participate in unit‑based IDR morning and afternoon huddles
• Coordinate referrals for DME, HH, and hospice
• Utilize predictive analytic software (e.g., JVION)
• Complete face‑to‑face patient assessments
• Communicate with assigned UR nurse and SW partner
• Reassess patients and document status of referrals and barriers
• Aids in the delivery of regulatory letters (IM, HINN)
• Integrate Inter Qual information during unit huddles and throughout the workday
• Provide medication assistance to patients identified in need (RX Help, CMAP)
• Initiate medication investigations (need for authorization, obtain co‑pay information)
• Communicate post‑acute care needs of inmates during transitions back to jail
• Assist in acute‑acute and transitions of care
• Maintain awareness and anticipate unit‑based patient needs
• Provide hand‑off communication of unit needs to peers during weekday/weekend transitions

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:

Demonstrated knowledge and competency in orientation completion, interpersonal oral…