RN Care Manager II

Registered Nurse Case Manager

The Registered Nurse Case Manager, as a key member of the Care Management team, is responsible for coordinating patient care across the continuum. This role integrates clinical expertise with knowledge of post-acute care needs and community resources to ensure safe, timely, and cost-effective transitions of care. The RN Case Manager applies principles of discharge planning, quality management, and resource utilization while collaborating with the multidisciplinary team to achieve optimal patient outcomes.

Essential Duties and Responsibilities:

• Demonstrates the knowledge base and essential psychomotor skills required to effectively carry out the job.
• Demonstrates the ability to interpret, analyze, and apply relevant data to prioritize and determine a course of action appropriate to meet the patients' management needs.
• Demonstrates effective communication and collaboration with culturally and professional interpersonal skills.
• Demonstrates effective time management and the initiative to carry out job responsibilities in a timely manner.
• Effectively assess, plans, implement and evaluates strategies that ensure the appropriate utilization of clinical resources and management of length of stay.
• Effectively assess, plans, implement and evaluates the effectiveness of the discharge plan for the assigned caseload of patients.
• Meets all organizational requirements. Demonstrates initiative to establish and achieve personal and professional goals.
• Demonstrates effective customer service behaviors as defined by the organizations mission, vision and values.
• Creates and implements discharge plan for every admitted patient. Assess each patient's medical, functional, psychosocial, legal/financial and safety/status, including self-care and environmental factors.
• Develops discharge plan tailored to the patients' needs and problems. Collaborates with physician, nurses and other ancillary staff, multidisciplinary team to make recommendations for effective, appropriate patient management.
• Comanage patient caseloads on a continuous basis in partnership with Social Worker Case Managers.
• Identify and address patients' and families' needs related to social determinants of health (SDOH), and refer to appropriate resources such as community agencies, private caregivers, behavioral health and psychosocial services, transportation assistance, medical and housing support, and educational materials.
• Implement the discharge plan and referral to services. Identify and resolve delays and obstacles to discharge. Acts as the primary leader of the discharge plan.
• Monitor patient length of stay and utilization of ancillary resources on an ongoing basis. Identify avoidable days and opportunities for process improvement and recommend actions to optimize efficiency and resource use.
• Communicates following the chain of command regarding proper utilization of resources, physician concerns, length of stay activities.
• Provide information as required regarding denials/approvals. Expedite the peer-to-peer process through collaboration with physician and insurance companies for post-acute activities.
• Communicate denials to patients, family, physician as needed specific to post-acute services.
• On a concurrent basis, enter all pertinent data (discharge plan) in data collections system as per policy/established process.
• Participates in clinical performance improvement activities as needed and as assigned.
• Completes readmission interviews with patients/families to help determine cause of readmission. Enters information into appropriate systems.
• Understands the intricacies and can interpret/negotiate with state, local and federal agencies to optimize placement of patients in the most appropriate setting. Assesses and aligns the needs of patients with placement option that are consistent with desired level of care.
• Works within the CMSA standards of practice.
• Serve on committee to promote advancement of organizational/departmental operations and practices.
• Serve as a preceptor for new hires and a mentor for other Case Managers.
• Other duties as assigned.
• Employee must be proficient in assigned job responsibilities within 90 days.

Supervisory Responsibilities:

Reports to: Director Case Management

Supervises: N/A

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience:

Minimum Required Education: Bachelor of Science in Nursing (BSN).

Experience: Minimum of Three (3) years of clinical nursing experience with one (1) year of Case Management experience required in acute or post-acute setting such as acute care hospital, post-acute rehabilitation, home health or community nursing setting.

Must be self-directed and possess critical thinking and excellent organizational skills.

Certificates, Licenses, Registrations:

• Active RN Licensure for the state of Virginia required.
• Must have active CPR certification and follow hospital policy for renewals; reference the RQI policy.
• Case Management Certification (ACMA or CCM) required within two (2) years of hire.

Required:

Bachelors or better in Nursing or related field.

Minimum of Three (3) years of clinical nursing experience with one (1) year of Case Management experience required in acute or post-acute setting such as acute care hospital, post-acute rehabilitation, home health or community nursing setting.

Basic Life Saving

Registered Nurse

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