Case Manager RN

Job Summary

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.

Essential Functions
Care Coordination

• Assist in coordinating clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Assists with effective care coordination and efficient care facilitation.
• Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
• Appropriately refers high risk patients who would benefit from additional support.
• Serves as a patient advocate.
• Knowledgeable of the principles of growth and development over the life span and the skills necessary to provide age-appropriate care to the patient population served.
• Participates in interdisciplinary patient care rounds and/or conferences.
• Collaborates with clinical staff in the execution of the plan of care, and achievement of goals.

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Must read, write and speak fluent English.
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers
• Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
• Must have regular attendance.
• Approximate percent of time required to travel, 0%.
• Performs other related duties as assigned.

Education

• Graduate of an accredited program required: LPN/LVN or RN.
• Master of Social Work with licensure as required by state regulations; or Bachelor of Social Work with licensure as required by state regulations.

Licenses/Certification

• Healthcare professional licensure required as LPN/LVN, Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.

Experience

• One year of experience in healthcare setting. 
• Experience in case management, utilization review, or discharge planning a plus.