Registered Nurse, Care Manager

• Provide coordination of care for patients to support safe, seamless, timely transitions across the continuum
• Identify, assess, plan, implement and evaluate options and services required to meet patients’ health and health-related needs, including social determinants
• Screen, identify and assess individuals needing active case management services
• Identify and prioritize patients using biopsychosocial, functional, cultural, spiritual and financial factors
• Plan with patients, caregivers and healthcare team members to maximize health care responses and quality and cost-effective outcomes
• Monitor and revise care plans when patient conditions change
• Complete clear, concise and timely patient-record documentation and handovers during care transitions
• Address post-hospital care needs and resources while incorporating patient and caregiver goals and preferences
• Follow standardized practices for Advance Care Planning, Length of Stay management and readmission prevention
• Support denial prevention and participate in Interdisciplinary Discharge Rounds
• Remove barriers to timely testing and treatment and offer alternatives to acute care
• Collaborate with revenue cycle partners to support appropriate patient classification
• Coordinate with patient access to ensure regulatory letters are delivered timely
• Participate in clinical outcome projects and process improvement initiatives
• Collaborate with peers and care-team members to achieve facility and department goals
• Support compliance with CMS rules and Conditions of Participation for discharge planning and utilization management
• Maintain awareness of community resources and clinical advancements

• BLS Basic Life Support – American Heart Association (required)
• RN License in the state in which they are working or covered by compact (required)
• Accredited Case Manager Certification (ACM), Certified Case Manager (CCM), or ANCC Nursing Case Management board certification (preferred)
• Bachelor of Science in Nursing (preferred for BSMH, required for RSFH)
• 1 year of experience in clinical setting (required)
• 3 years of experience in an acute care clinical setting (preferred)
• Ambulatory or post-acute care coordination experience (preferred)
• Knowledge of reimbursement methodologies
• Knowledge of staffing workflow and bed allocation
• Clinical knowledge
• Working knowledge of local and state resources
• Knowledge of government and non-government payor practices, regulations, standards and reimbursement
• Attention to detail
• Critical thinking
• Communication with family members
• Conflict resolution
• Problem solving
• Active listening
• Relationship building
• Teamwork
• Facilitation

Demonstrates expertise in care coordination, patient assessment, and case management to ensure effective transitions and optimal health outcomes. Proficient in compliance with regulatory standards and collaboration with interdisciplinary teams to enhance patient care.

• RN License
• BLS Basic Life Support
• Accredited Case Manager Certification
• Clinical Knowledge
• Experience in Acute Care Clinical Setting

• Care Coordination
• Patient Assessment
• Case Management
• Advance Care Planning
• Documentation
• Reimbursement Methodologies
• Utilization Management
• Clinical Outcome Projects
• Process Improvement
• Knowledge of Community Resources

• Attention to Detail
• Critical Thinking
• Communication
• Conflict Resolution
• Teamwork

• BLS Basic Life Support
• RN License
• Accredited Case Manager Certification
• Certified Case Manager
• ANCC Nursing Case Management Board Certification

• Patient Care
• Health Care Transitions
• Social Determinants of Health
• Interdisciplinary Collaboration
• CMS Compliance
• Post-Acute Care
• Ambulatory Care
• Government Payor Practices
• Non-Government Payor Practices
• Length of Stay Management