RN Care Manager

Job Description

The Care Manager - RN is responsible for coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves collaborating with interdisciplinary teams, reviewing medical records for appropriateness and medical necessity, and maintaining compliance with federal, state, and accreditation standards.

Essential Functions

• Conducts daily reviews of medical records to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services.
• Collaborates with interdisciplinary teams (IDT) to ensure effective communication and coordination of patient care, including identifying avoidable days and resolving care transition issues.
• Develops and implements discharge plans, coordinating post-hospital placement and social services to meet patient needs.
• Refers cases to physicians or managers when patients do not meet established criteria, ensuring timely and appropriate interventions.
• Serves as a liaison with community agencies, maintaining relationships and facilitating seamless transitions for discharged patients.
• Facilitates interdisciplinary meetings to address patient care needs, resolve challenges, and support collaborative care planning.
• Maintains accurate and timely documentation of case management activities, including records of referrals, patient interactions, and compliance with reporting requirements.
• Identifies and appropriately refers cases to Child/Adult Protective Services, ensuring compliance with legal and ethical standards.
• Provides professional assistance to patients, families, and physicians regarding discharge planning and post-hospital care options.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• Bachelor's Degree in Nursing preferred
• 2-4 years of clinical nursing experience in a hospital, home health, or nursing home setting required
• 2-4 years of care management experience preferred

Knowledge, Skills and Abilities

• Strong understanding of case management principles, discharge planning, and transitions of care.
• Knowledge of federal, state, and Joint Commission standards related to case management.
• Excellent communication and interpersonal skills to collaborate effectively with patients, families, and interdisciplinary teams.
• Ability to assess complex situations, identify solutions, and implement care plans efficiently.
• Proficiency in electronic medical records (EMR) and documentation systems.
• Strong organizational and time management skills to prioritize tasks in a dynamic environment.

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required
• BLS - Basic Life Support preferred

State Specific Requirements

• Alabama: Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred.
• New Mexico: Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications preferred.