Case Manager, RN (Registered Nurse) - Care Management

Washington Hospital, Inc., Mary Fredericksburg, VA
- Associates of Science or Certificate in Nursing

* RN License

* 2 years recent acute in-hospital experience

Job Summary:

The Case Manager, RN oversees the care coordination of patients towards realistic and desirable outcomes. The incumbent will organize and expedite a treatment plan of care activities; identify discharge needs and develop a discharge plan; promote communication and collaborative coordination amongst care providers and provide information and education on community resources. Additionally, the Case Manager, RN will coordinate care of patients with clinical partners and monitor appropriateness of admissions and continued stay documents. The incumbent of this position will demonstrate a commitment of quality service to our patients, the community, and our co-workers.

Essential Functions & Responsibilities:

Identifies and screens high-risk patients for care coordination. Coordinates care of patients with clinical partners; helps patients advance towards realistic and desirable outcomes. Organizes and expedites treatment plan of care activities. Assesses for long term and/or future patient care needs by identifying probable changes in level of independence or functional quality. Identifies tentative discharge needs and develops a working discharge plan within the first 48 hours of admission. Develops, coordinates and communicates discharge plans with the patient, family members and care team and promotes communication and collaborative coordination of care amongst care providers. Documents assessment and overall discharge plan in medical record. Manages patient/family/physician expectations.

Communicates activity status updates regarding treatment plan with clinical partners. Provides information and education on community resources to patient and their families. Applies clinical appropriateness criteria to monitor appropriateness of admissions and continued stay and documents and relays to associated physician accordingly. Refers cases to physician advisor per UR policy as appropriate. Manages any denials related to information provided to/received from payers.

Assures that key regulatory requirements are met. Documents key updates using appropriate software. Delivers appropriate regulatory letters to patients and families.

Collaborates with leadership to appropriately address concerns related to delays in discharge, barriers to discharge and trends noted. Identifies barriers to timely discharge and treatment and works to remove those barriers to timely and efficient care delivery.

Collects delay data for outcome and key performance indicators and documents accordingly.

Provides post-discharge support as needed via telephonic follow up or face-to-face contact with patients for care coordination services.

Performs other duties as assigned.

Qualifications:

Education, Experience and Qualifications:

Associate's or Bachelor's degree in Nursing

Two years of experience in acute care hospital setting

Experience with computer technology, specifically experience with Windows based programs, e-mail, and Microsoft Word.

Preferred:

Knowledge and experience in utilization management, discharge planning or case management

License and/or Certifications

Required:

Valid RN Licensure in the Commonwealth of Virginia or reciprocal state