Case Manager, RN - PRN

East Cooper Medical Center is one of South Carolina's leaders in healthcare. Our approach to medicine is designed to provide patients with successful outcomes, fast recovery times, and a better quality of life. Our hospital combines technology and clinical expertise with compassion to provide personalized care for a lifetime. Our expanded scope of services, our commitment to quality & safety, and our outstanding team of caregivers have attracted patients throughout the Lowcountry and beyond, and have contributed to or hospital being nationally recognized. Interested in joining our team? Apply today!    Position Summary The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination.  The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions.  This position integrates national standards for case management scope of services including:   Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care  Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy Education provided to physicians, patients, families and caregivers   The individual’s responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) care coordination, c)  transition planning assessment and reassessment, d) implementation or oversight of implementation of the transition plan, e) leading and facilitating multi-disciplinary patient care conferences, f) managing concurrent disputes, g) making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services, i) communicating with patients and families about the plan of care, j) collaborating with physicians, office staff and ancillary departments, k) leading and facilitating Complex Case Review, l) assuring patient education is completed to support post-acute needs , m) timely complete and concise documentation in Case Management system, n ) maintenance of accurate patient demographic and insurance information, o) identification and documentation of  potentially avoidable days, p) identification and reporting over and underutilization, q) and other duties as assigned.   Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.    Other Qualifications Current license as a Registered Nurse in the State of South Carolina. BSN or MSN preferred. Minimum of three (3) years of hospital-based clinical experience preferred.  Previous Case Management, Utilization Review or Discharge Planning experience desirable.  Requires effective communication with patients, families, nursing, medical staff, and ancillary departments.  Ability to take initiative to resolve problems immediately and implement change in a timely basis.  Must be self-directed and able to adapt to change.   Supervisory Responsibilities None   Work Environment Category 1-2 Blood Exposure Works in a clean, well-lighted, heated and ventilated hospital complex.  Subject to personal injury when involved in restraint care of hostile, combative patients and family members.  Subject to exposure to communicable diseases and infections.  Subject to exposure to radiation in assisting with x-ray procedures on critical patients.  Subject to cuts, punctures, and electrical shock when utilizing various equipment and supplies.  Subject to muscular strain when lifting, moving, turning and transporting patients.  Stands and walks throughout the day.  Assists in lifting, moving, turning, restraining, and transporting patients.  Utilizes a variety of standard nursing equipment/supplies, and maintains competency in their operation.   Services Rendered (Home and Float Units)   Medical/Surgical/Telemetry        Peri/Intraoperative   Emergency   Labor/Postpartum/GYN    Critical Care   Pediatrics     Progressive Care   Nursery/Level I & II   PACU       Day Surgery   Block Suite   Endoscopy