RN Case Manager

Job Title: Case Manager RN (Registered Nurse)

Job Summary:

A Case Manager RN is responsible for coordinating and overseeing patient care for individuals with complex healthcare needs. The role involves assessing, planning, implementing, and evaluating patient care plans to ensure that patients receive the necessary medical and community resources. Case Manager RNs work with healthcare providers, patients, families, and insurance companies to facilitate appropriate care, reduce hospital readmissions, and improve health outcomes.

Key Responsibilities:

1. Patient Assessment:

• Conduct comprehensive assessments of patients’ medical, social, and psychological needs.
• Identify care goals and barriers to health and well-being.
• Collaborate with interdisciplinary teams to develop a personalized care plan.

1. Care Coordination:

• Coordinate and manage the patient’s care across the continuum (hospital, home, outpatient services).
• Ensure timely delivery of healthcare services and facilitate communication among the patient, healthcare providers, and family.
• Monitor patient progress and adjust the care plan as needed.

1. Education and Advocacy:

• Educate patients and their families about the patient's condition, treatment options, and health management strategies.
• Serve as an advocate for patients, ensuring their needs are met and their rights are upheld.

1. Documentation and Reporting:

• Maintain accurate, thorough documentation of patient interactions, care plans, and outcomes.
• Prepare reports for internal and external stakeholders (e.g., insurance companies, healthcare providers).
• Ensure compliance with regulatory requirements, including quality assurance standards.

1. Resource Management:

• Identify community resources and services that can help patients manage their health outside of clinical settings.
• Assist with the coordination of services such as home health care, medical equipment, and transportation.

1. Collaboration and Communication:

• Work closely with physicians, specialists, social workers, and other healthcare professionals to optimize patient care.
• Maintain effective communication with the patient and family to ensure care continuity.

1. Discharge Planning:

• Coordinate safe discharge plans for patients transitioning from hospital to home or another care setting.
• Ensure follow-up care appointments and services are in place before discharge.

1. Quality Improvement:

• Participate in quality improvement initiatives and contribute to improving patient care delivery.
• Review patient outcomes to identify opportunities for better care coordination and service delivery.