Case Manager RN, Social Services

Description

• 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.
• The RN CM will begin the process of care coordination at the time of the patient's admission by completing a thorough admission assessment and/or psychosocial assessment which will allow for a timely and accurate capture of information as well as foster the ability to begin working towards a discharge plan.
• The RN CM is an integral part of the interdisciplinary care team who is required to attend rounds, care conferences, and/or care team meetings.
• The RN CM will act as a representative of both the hospital care team and the patient/family in an effort to balance patient/family choice and projected care coordination needs with the ability to execute such services.
• The RN CM will work with the hospital care team and the patient/family in order to plan and implement the best possible plan for the patient while taking various factors, limitations, and patient/family preference into consideration.
• The RN CM will identify and recommend post-acute services and will complete referrals to appropriate post-acute care providers in a timely manner, coordinating directly with the patient/family as well as the care team.
• Through continuous assessment and review, the RN CM will apply critical thinking to ensure alignment and appropriateness of post ¿acute services as the patient clinically progresses throughout their stay.
• Ultimately, the RN CM is responsible for ensuring the discharge plan is aligned to be executed with the patient¿s medically cleared for discharge date as well as the projected length of stay as provided by the payor.
• The RN CM identifies and participates in the development of strategies to reduce unnecessary length of stay and/or resource consumption.
• The RN CM escalates cases, as appropriate, to management, Physician Advisor, Complex Care team and/or Ethics committee.
• It is the role of the RN CM to educate patients/families as well as the care team as it relates to post acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices and available resources.
• The RN CM provides supportive and therapeutic communication for patients, families and loved ones who are experiencing anxiety or stress due to illness, injury or physical limitations.
• The RN CM must communicate confidently, effectively, and therapeutically while being assertive and conveying an impression which reflects favorably upon the organization.
• The RN CM will initiate and facilitate discussions with the payors in order to act as an advocate on behalf of the patient and hospital in an effort to reduce non-covered, non-authorized, or denied services.
• The RN CM will issue and administer notices of non-coverage and potential liability to patients in accordance with predetermined regulations, policies, and procedures.
• The RN CM serves as a resource to the Physician, Interdisciplinary Care Team, and patient for the interpretation of external regulations and organizational policies and procedures as it pertains to Discharge Planning and Care Coordination.
• The RN CM will ensure compliance with all regulatory requirements as it relates to Government and Commercial Payors.
• The RN CM will ensure compliance with all third party payers and federal and state regulatory agencies.
• The RN CM will ensure proper use of Case Management Systems and workflows.
  MINIMUM QUALIFICATIONS:
• Must have a valid, active unencumbered Nursing license or temporary permit approved by the Georgia Licensing Board.
• Bachelor's degree in nursing preferred or actively being pursued. 2 years recent healthcare experience required.
• 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 in a constructive manner.