RN Case Manager

About This Role

The RN Case Manager utilizes advanced clinical skills to assess, plan, intervene, and evaluate patient care in accordance with Federal, State, and TJC standards. This role collaborates with the interdisciplinary team, patient, and family to achieve optimal clinical outcomes through effective resource utilization and discharge planning.

Responsibilities

• Initiate care transition and develop individualized discharge plans for each patient
• Identify at-risk populations using approved screening tools to prevent readmission
• Practice autonomously, consistent with evidence-based standards
• Serve as a case management resource expert for compliance with regulatory requirements (Medicare IM letter, 3008, 1823 PASSR, DCF mandatory legal reporting)
• Work with Utilization Department, Physician Advisors, Hospitalists, and other physicians to ensure appropriate, cost-effective care and best patient outcomes
• Proactively identify and either resolve or escalate delays and obstacles to discharge
• Identify reimbursement factors influencing choice of post-hospital providers and obtain authorizations when required
• Evaluate overall patient daily plan for effectiveness and involve patient and family in formulating plan goals
• Collaborate and maintain active communication with physicians, nursing, and other interdisciplinary team members for timely patient resource management and transition
• Demonstrate professional accountability through supporting patient’s rights, informed consents, and advanced directives
• Initiate appropriate referrals to ethics committee, clinical social worker, risk management, or legal services as needed

Requirements

• Associate Degree in Nursing
• Current, valid State of Florida RN license or endorsement
• Current American Heart Association Basic Life Support Healthcare Provider Completion Card
• At least three (3) years of clinical experience in an acute care hospital
• Strong analytical, data management and computer skills
• Excellent interpersonal communication and negotiation skills
• Demonstrated critical thinking in resolving or escalating barriers
• Ability to work autonomously and prioritize multiple tasks and role components
• Ability to exercise sound judgment in interactions with physicians, payers, patients and their families
• Flexibility to meet needs in sometimes high demand and stressful situations

Qualifications

• Associate Degree in Nursing
• At least three (3) years of clinical experience in an acute care hospital.

Nice to Have

• BSN or Bachelor’s Degree in related field
• Case Management experience in an acute care hospital
• Knowledge of care transitions, utilization management, case management, performance improvement and managed care reimbursement
• Comprehensive knowledge of continuum-of-care post-acute community resources
• CCM or ACM certification

Certifications