Care Manager Registered Nurse

Job Summary

Job Duties

Works with physician and multidisciplinary team members to develop plan of care for each assigned patient from admission through discharge. Ensure patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and evaluations. Assess and respond to patient and family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care.

• Works in conjunction with physicians, nurses, inter disciplinary team and others to assess, plan and initiate patient plan of care.
• Facilitates and coordinates details of the actual discharge to appropriate agencies.
• Facilitates and coordinates an individualized care coordination plan.
• Serves as a resource to physician and hospital personnel regarding available agency, facility, and community services to assist in discharge planning.
• Completes appropriate federal, state and local forms.
• Ensures adherence to quality standards and participation in quality monitoring and improvement by monitoring quality of care using predetermined criteria, reporting potential risk and quality management issues identified from medical record review to appropriate departments through defined processes, and enters data as requested and appropriate for role, to support quality improvement initiatives into appropriate system.
• Conducts on-going case review for delays or variances in care; raises issues with appropriate department, attending physician and physician designee.
• Captures data per department policy.
• Communicates to appropriate physician identified issues for resolution and intervention.
• Uses approved medical necessity criteria as a tool to ensure that patients meet appropriateness of the setting.
• Actively involves payer liaison role in any case that has potential of not meeting medical necessity guidelines.
• Supports payer liaison role to resolve barriers through appropriate administrative and medical channels to avoid third party payer denials.
• Maintains awareness of all concurrent denials through interaction with payer liaison.
• Works with payer liaison to facilitate timely discharge or alternative plan of care acceptable to physician, family and payer.

Work is typically performed in a clinical and office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.

Position Details

Work Schedule:

• Typical hours are from 9:00AM to 7:30PM - 4 days a week
• May require future on call and weekends as needed
• Travel up to 25% may be required for trainings and meetings

We're proud to offer competitive salaries and a comprehensive benefits package that includes:

• Medical, prescription drug, vision and dental coverage
• Family Support (Fertility and Adoption Support)
• Employer contribution to your retirement plan
• Tuition assistance (part time and full time roles only)
• Generous paid time off packages that allows you to take the time you need to travel, rest, and care for and reconnect with friends and family.
• Professional opportunities for growth and advancement 
• Support and mentorship from a full range of dedicated and experienced nursing leaders
• Community Involvement through our Employee Resources Groups 
   

Education

Experience

Certification(s) and License(s)