RN - Case Manager

Care Manager, Registered Nurse

The Nurse will serve as an Outpatient/Inpatient Case Manager. They will be the supportive contact for specified groups of identified high-risk patients. The focus will be on specialty clinics that require specific Case Management attention. The case manager will meet essential health and social needs for patients while ensuring quality and cost-effective healthcare. They will facilitate care transitions from admission through discharge, ensuring continuity of care. This includes the alignment of services and post-hospital referrals to continuing care agencies. The case manager will also serve as a resource for nursing staff, physicians, and ancillary departments regarding transitional and regulatory issues. They will work with culturally diverse patient populations facing barriers to self-sufficiency such as illiteracy and substance abuse. The Nurse Case Manager will be responsible for assessment, service planning, resource acquisition, monitoring progress, and responding to emerging client needs. They will collaborate with an interdisciplinary team to assess care plans, monitor progress, and provide recommendations for safe and efficient hospitalizations. Additionally, they will evaluate patients in the emergency department for medical necessity and care coordination needs. This includes assessing potential admissions and working with advanced practice clinicians and physicians to determine appropriate admission status. The nurse will propose and implement outpatient plans for safe discharge from the emergency department with physician approval. They will coordinate care for patients experiencing abuse, chronic pain, and frequent utilization issues. The role entails interaction with patients across all age groups, from newborns to geriatrics. The Nurse will also work with individuals experiencing mental health issues to help them access and navigate necessary resources for improvement in well-being. Demonstrated knowledge of case management, contract health, and utilization review processes is a plus.