The RN Case Manager facilitates patient care coordination, discharge planning, and resource management to ensure optimal clinical outcomes. They perform regular patient assessments, collaborate with interdisciplinary teams, and manage transitions of care across the health continuum.
Requirements summary
Requires a Bachelor's degree in Nursing and current Virginia RN licensure, with at least three years of recent clinical experience in a hospital setting. Candidates must demonstrate competency in case management, discharge planning, and utilization management.
Healthcare: Friday, Saturday, Sunday, 7am-7pm The RN Case Manager provides case management for assigned patient populations. Utilizes clinical expertise, communication and problem-solving skills to achieve optimal clinical and resource outcomes. Promotes cost-effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization. Performs patient needs assessments upon admission and at regular intervals, facilitating referrals and providing linkages to health, wellness, and post-acute care resources across the health care continuum. Promotes interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan. Promotes appropriate length of stay, resource management, and care transitions to the next level of care. Must comply with all federal and state regulations surrounding the discharge process. Must possess knowledge of growth and development appropriate to age group served and incorporate plan to meet needs into plan of care. The RN Case Manager provides case management for assigned patient populations. Utilizes clinical expertise, communication and problem-solving skills to achieve optimal clinical and resource outcomes. Promotes cost-effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization. Performs patient needs assessments upon admission and at regular intervals, facilitating referrals and providing linkages to health, wellness, and post-acute care resources across the health care continuum. Promotes interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan. Promotes appropriate length of stay, resource management, and care transitions to the next level of care. Must comply with all federal and state regulations surrounding the discharge process. Must possess knowledge of growth and development appropriate to age group served and incorporate plan to meet needs into plan of care. Collaborates with Utilization Review Nurse. Maintains regular contact with assigned Utilization Review Nurse throughout the day. Uses InterQual software to support accurate patient statuses according to ongoing medical necessity. Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non-coverage, using support staff as appropriate. Ensures documentation accurately reflects the patient’s condition, co-morbidities, treatment and procedures that support the most appropriate admission status and DRG assignment. Communicates with patients/families to ensure understanding financial implications of discharge plans Facilitates an interdisciplinary approach to patient care. Actively participates in Interdisciplinary Team Meetings on assigned units, sharing meaningful and professional knowledge to the team discussion regarding progression of care. Provides feedback to the health care team verbally and via chart entries regarding the patient's progress toward reaching expected outcomes or about barriers to the plan. Manages changes to the plan as necessary. Maintains effective communications with all disciplines to promote timely and appropriate discharges.
Benefits
Paid time off
Discounts on childcare
Continued education and training
Employer funded pension plan
Onsite fitness studios
Voluntary 403b
Discounts to carilion wellness centers
Health and wellness app access
Comprehensive medical, dental, & vision benefits
Daily communication with
Social
Work and
Utilization
Review: includes case reviews, morning touchpoints, and ongoing throughout the workday. Coordinates care and services within the case managed population. Performs face-to-face assessments of patients/families when appropriate to identify individualized needs in collaboration with SW. CM will review assigned census beginning each day with their SW partner to determine patient statuses and needs for the day. Documentation in the medical record is completed in the appropriate time frame, accurately reflecting the plan of care and CM interventions. Complies with CMS regulations related to discharging planning documentation. Coordinates referrals of post-acute services such as home health (HH), hospice, and durable medical equipment (DME). Directs liaison activities to appropriately integrate with the patient and into the health care continuum. Facilitates appropriate referrals surrounding high-cost medications for all patients, insured or uninsured. Works with other disciplines along with support staff to obtain prior authorizations and/or co-pay information to ensure medication needs are met for discharge and do not create a barrier.
Ensures coordination of care when patients are transferred: acute hospital to acute hospital, and jails/prisons. Communicates with outside nursing or case management staff as appropriate for smooth transition. Advocates for the patient and family throughout the entire episode of care. Participates in departmental and system performance improvement Initiatives. Contributes to Carilion Clinic’s performance improvement activities by engaging with predictive analytic software. Collects and analyzes relevant patient care and fiscal data. Analyzes and evaluates the effect of case management on quality outcomes and fiscal parameters. Complies with all departmental policies and practices and fosters teamwork and professionalism. Summary List of Daily Tasks / Expectations of the Nurse Case Manager Role Participate in Unit-based IDR morning and afternoon huddles Coordinate referrals for
DME,
HH,
Hospice
Utilize predictive analytic software (example: JVION) Complete face-to-face patient assessments Communicate with assigned UR nurse and SW partner Reassess patients and document status of referrals, movement on barriers Aids in the delivery of regulatory letters (IM, HINN) Integrates InterQual information during unit huddles and throughout workday as appropriate Provides Medication Assistance to patients identified in need (RX Help, CMAP) Initiates Medication Investigations (need for authorization, obtain co-pay information) Communicate post-acute care needs of inmates during transitions back to jail Assist in acute-acute and transitions of care Maintain awareness and anticipate unit-based patient needs Provide hand-off communication of unit needs to peers during weekday/weekend transitions
What
We
Require:
Education: Registered Nurse. Bachelor's degree required. 5 years of RN experience in a hospital setting may be considered in lieu of a bachelor's degree.
Experience
Three years of recent experience in a clinical health care setting with responsibilities reflecting direct management of patient care including planning, coordination, and delivery of needed services such as education, psychosocial support, discharge planning and utilization management. Supervisory or leadership experience is preferred.
Licensure, certification, and/or registration: Current licensure in Virginia as a Registered Nurse.
Life
Support: AHA BLS- HCP required within 6 months of hire. Other Minimum
Qualifications
Must demonstrate knowledge and competency in the following areas: satisfactory completion of orientation; positive interpersonal oral communication skills; effective written communication skills; integrity; innovation; team player; courteous; ability to resolve complaints/problems; customer-focused philosophy of service delivery; ability; willingness to work as an integral member of a multi-skilled team. Also demonstrate knowledge and competency in; computer literacy; community and system resources; effective interpersonal relations; assertiveness; flexibility; perseverance; diplomacy and negotiation. This job description is only meant to be a representative summary of the major responsibilities and accountabilities performed by the incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.
Recruiter
DANA
JOHNSON
Recruiter
Email: dejohnson@carilionclinic.org For more information, contact the HR Service Center at 1-800-599-2537.
Carilion
Clinic is an
Equal
Opportunity
Employer: We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age (40 or older), disability, genetic information, or veterans status. Carilion is a Drug-Free Workplace. For more information or for individuals with disabilities needing special assistance with our online application process contact
Carilion
HR
Service
Center at 800-599-2537, 8:00 a.m. to 4:30 p.m., Monday through Friday.
For more information on
E-Verify: https://www.carilionclinic.org/eoe-e-verify-and-right-work-policies Benefits, Pay and Well-being at Carilion Clinic Carilion understands the importance of prioritizing your well-being to help you develop and thrive. That’s why we offer a well-rounded benefits package, and many perks and well-being resources to help you live a happy, healthy life – at work and when you’re away. When you make your tomorrow with us, we’ll enhance your potential to realize the best in yourself.
Below are benefits available to you when you join
Carilion: Comprehensive Medical, Dental, & Vision Benefits Employer Funded Pension Plan, vested after five years (Voluntary 403B) Paid Time Off (accrued from day one) Onsite fitness studios and discounts to our Carilion Wellness centers Access to our health and wellness app, Virgin Pulse Discounts on childcare Continued education and training In our workplace, we're devoted to the success of our employees. No matter where you are in your career, we will help you continue to learn, grow, and share your knowledge with others. Introduce yourself to our recruiters and we'll get in touch if there's a role that seems like a good match. Join an organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, fully dedicated, and forever curious. Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, and multi-specialty physician practices spanning southwestern Virginia. Join us and begin your career in a place where every day is a new adventure of creating the future of health care.
