RN Case Manager
The RN Case Manager is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience. The RN Case Manager works in collaboration with the Physician, Medical Social Worker, and bedside RN to assure the timely movement of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. Oversees the management of acute patient populations across the care continuum with the primary focus to provide coordinated, timely and integrated care. The RN Case Manager reports to either the Supervisor or Manager or Director of Care Coordination in each facility. The RN Case Manager has frequent contact with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources.
- Utilize critical thinking skills and clinical knowledge to create a viable and effective patient transition plan and identify delays in service, or quality issues that impede the progression of care required.
- Advanced Knowledge and understanding of governmental healthcare reimbursement systems is required
- Intermediate/Advanced knowledge of healthcare reimbursement systems: HMO, PPO, capitated agreements, DRGs, etc., preferred.
- Intermediate/Advanced knowledge & understanding of post-acute healthcare resources such as SNF, HH, Hospice, etc.
- General knowledge of coding and DRG assignment process preferred.
- Must be able to effectively communicate with, and promote cooperation and collaboration between, multiple people including patients and their families, physicians, nurses, social workers, etc.
- Ability to seek input and receive feedback in a collaborative interdisciplinary team.
- Able to orchestrate successful, complex transition plans.
- Must be able to develop an organized work plan in a high-volume environment with rapidly changing priorities.
- Must possess leadership, delegation, and supervisory skills to guide staff and hold others accountable.
- Must be self-directed and organized with the ability to independently prioritize and follow through to achieve desired clinical, satisfaction and financial outcomes.
- Must have strong clinical assessment skills necessary to provide utilization review and transition planning services to meet the patients' complex medical, emotional, and social needs.