Employment Type:

Full time

Shift:

Day Shift

Description:

The RN Case Manager is responsible for coordinating patient care activities within the ED setting to ensure appropriate utilization of healthcare services, improve patient outcomes, and support efficient patient flow. This role collaborates closely with physicians, nursing staff, and interdisciplinary teams to assess patients upon presentation and facilitate safe, timely, and appropriate care decisions.
This role focuses on reducing avoidable admissions and readmissions by identifying alternative levels of care, connecting patients with community resources, and supporting discharge planning from the point of entry.
This position plays a key role in enhancing throughput, supporting population health initiatives, and advancing the organization’s commitment to high-quality, patient-centered care.

 Essential Functions and Responsibilities

Uses approved criteria for admission and continued stay reviews to ensure appropriate setting and timely implementation of plan of care. Collaborates with admitting and/or attending physicians regarding appropriate level of care/status determination. Consults with Physician Advisor and administrative leadership as necessary for those patients not meeting medical necessary services for acute care. Effectively organizes and sets priorities on assignment caseload. Knowledge of Medicare, Medicaid and non-governmental payer regulations for patient care requirements. Timely completion of initial and concurrent reviews, to include OBS management. Completes biopsychosocial assessment of patients to determine post-acute needs. Implements safe discharge/treatment plans in a timely manner to prevent avoidable inpatient stays. Explores options with patient/family and appropriately assists in the decision-making process. Communicates discharge planning activities with interdisciplinary team daily through the maintenance of concurrent documentation and/or verbal report. Refers cases to home health, hospice, skilled nursing care facilities, DME companies, and other OP services and provides concurrent information as required. Assures response to and documentation of received referrals/consultation within 24 working hours. Is a patent advocate. Identifies community resources and maintains working relationships with referral agencies.  Demonstrates service excellence by following HIPAA guidelines and meeting the Conditions of Participation set forth by the Center of Medicare and Medicaid Services (CMS). Identifies, processes, and documents CC44 accounts appropriately. Serves as a resource to the healthcare team.   Evaluates hospitalized patients to ensure they are receiving services at the most appropriate and cost-effective level of care in collaboration with attending physicians and Physician Advisors. Maintains good rapport and cooperative relationships.  Approaches conflict in a constructive manner.  Helps to identify problems, offer solutions, and participate in their resolution. Demonstrates self-directed learning. Maintains the confidentiality of information acquired pertaining to patients, physicians, employees, and visitors to Trinity Health facilities. Discusses patient and hospital information only among appropriate personnel in appropriate private places. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management. Behaves in accordance with the Mission, Vision, and Values of St. Mary’s Health System. Attend team huddles and meetings when working; if unable to attend then review of notes/minutes from meetings is required.  Staff are accountable to know the content of discussions. Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior.

OTHER FUNCTIONS AND RESPONSIBILITIES

Performs other duties as assigned.

Professional Development

All Registered Nurses are expected to engage in professional role activities, including leadership, appropriate to their education and position. Registered nurses are accountable for their professional actions to themselves, their healthcare consumers, their peers and to society. The RN Case Manager is recognized as an expert in professional practice. The RN Case Manager is expected to contribute to the professional growth of others by acting as a preceptor, clinical coach, and mentor.

Required Education, Experience and Certification/Licensure

Licensure/Certification/Registration: Current GA RN license. Case Management Certification preferred. BLS required.

Education: Must be a graduate of an accredited school of nursing, BSN recommended.

Experience: Minimum 2 years’ experience in nursing in a hospital setting; preferred 1 year in case management, utilization management, or discharge planning .

Required Skills and Abilities

Clinical and analytical skills necessary to facilitate collection of patient clinical information from medical records and to objectively apply various criteria as dictated by CMS. Strong organization and prioritization skills. Strong interpersonal and communication skills, including telephonic and electronic Ability to concentrate and pay close attention to detail. Computer Skills:

• Required: Basic keyboarding skills
• Preferred:
  • EPIC
  • Microsoft Word
  • Microsoft Teams
  • Microsoft Outlook
  • Microsoft Excel

Degree of Supervision Required: Indirect and periodic supervision.  Must be capable of working independently.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.