RN Care Manager (Discharge Planning)

Overview The RN Case Manager (RN CM) is responsible for patient care coordination from admission through discharge; ensuring smooth transitions of care as the patient is discharged from the hospital setting, ensuring and facilitating high quality clinical and cost outcomes, procuring and securing post-acute services, coordinating and advocating for patients and families with both internal and external stakeholders, and identifying and addressing potential barriers to care coordination/discharge planning in an effort to foster efficient care delivery and maximize reimbursement. Responsibilities Care Coordination and Discharge Planning: Begin the process of care coordination at admission by completing a thorough admission and/or psychosocial assessment to enable timely discharge planning. Attend rounds, care conferences, and care team meetings as an integral part of the interdisciplinary care team. Represent the hospital care team and the patient/family to balance patient/family choice with care coordination needs and the ability to execute services. Plan and implement the best possible plan for the patient while considering factors, limitations, and patient/family preferences. Identify and recommend post-acute services and complete referrals to appropriate post-acute care providers in a timely manner, coordinating with the patient/family and care team. Apply continuous assessment and critical thinking to ensure alignment and appropriateness of post-acute services as the patient progresses. Ensure the discharge plan aligns with the medically cleared discharge date and projected length of stay provided by the payor. Identify and participate in developing strategies to reduce unnecessary length of stay and resource consumption. Escalate cases as appropriate to management, Physician Advisor, Complex Care team, and/or Ethics committee. Education and Patient Support Education: Educate patients/families and the care team about post-acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices, and available resources. Communication: Provide supportive and therapeutic communication to patients, families, and loved ones experiencing anxiety or stress due to illness or injury. Professionalism: Communicate confidently, effectively, and therapeutically while being assertive and representing the organization positively. Regulatory Compliance and Payor Coordination Payor Liaison: Initiate and facilitate discussions with payors to advocate for the patient and hospital, aiming to reduce non-covered, non-authorized, or denied services. Non-Coverage Notices: Issue and administer notices of non-coverage and potential liability to patients per regulations, policies, and procedures. Interpretation: Serve as a resource for external regulations and organizational policies as they pertain to discharge planning and care coordination. Compliance: Ensure compliance with regulatory requirements related to government and commercial payors, third-party payers, and federal/state agencies. Systems: Ensure proper use of Case Management Systems and workflows. Minimum Required Qualifications Education: Bachelor’s degree in nursing preferred or actively being pursued. Experience: 2 years of recent healthcare experience. Licensure: Valid, active unencumbered nursing license or temporary permit approved by the Georgia Licensing Board. Must meet all quality and productivity expectations and successfully complete yearly competencies. Must obtain 4 CEU credits per year related directly to core job functions, in addition to yearly competencies. Must actively participate in process improvement initiatives by sharing thoughts and ideas constructively. Physical Requirements Light physical activity (0-33% of the workday occasionally; 34-66% frequently; 67-100% constantly). Lifting up to 10 lbs; carrying small articles; occasional standing and walking; frequent sitting; close eye work (computers, typing, reading, writing). Physical demands may vary by work area and tasks. Environmental Factors Environmental conditions may vary by work area and tasks. Exposures may include blood-borne pathogens, bio-hazardous waste, chemicals/gases/fumes/vapors, communicable diseases, electrical hazards, and other typical healthcare environments. Shift work, travel may be required; use of personal protective equipment including respirators. Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at View email address on click.appcast.io. One week's advance notice is preferred. Additional Information Scheduled Weekly Hours: 4 #J-18808-Ljbffr