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Registered Nurse RN Care Manager
2 months ago
- Benefits and Paid Days Off from Day One
- Shift: Days M-F with 4 weekend shifts in a 6 week period
The Role You’ll Contribute
The RN Care Manager in collaboration with the patient/family, social workers, nurses, physicians and the interdisciplinary team, ensures patient-centered care coordination and progression through the continuum of care. The RN Care Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general supervision of the Care Managment Supervisor or Manager or Director of Nursing and is responsible for patient evaluations of post-hospital needs; development of a transition of care plans and initiation of the implementation of the transitions of care plans prior to the discharge of the patient. The RN Care Manager is responsible for optimal patient flow/throughput to enhance continuity of care, smooth and safe transitions, patient satisfaction, patient safety, readmission prevention and length of stay management. The RN Care Manager communicates daily with the interdisciplinary team during daily multidisciplinary rounds. Care coordination, discharge planning, transitions of care planning and understanding of medical necessity are core competencies of this role. The RN Care Manager facilitates the collaborative management of patient care across the continuum, intervening to remove barriers to timely and efficient care delivery and reimbursement.
The Value You’ll Bring To The Team
- Completes Initial Evaluation for transition of care needs on all identified patients within one calendar day of admission and documents according to policies and procedures. Interviews patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the Initial Evaluation.
- Reviews necessary patient information including labs, medications (Pre and post hospital), History and Physical, Therapy notes, ED notes, test results and progress notes.
- Incorporates the patient/family care goals and preferences as much as possible into the transition of care planning and communicates these goals and preferences to the multidisciplinary team.
- Meets with patient/families to discuss realistic and appropriate discharge options and providers of post-hospital care.
- Collaborates with the multidisciplinary healthcare team daily in multidisciplinary rounds to efficiently communicate and facilitate high quality patient progression of care and transitions plans.
- Consults Social Work for specialty services related to psychosocial needs, decision making needs for patients who lack capacity, patient/family adjustment needs and psychosocially complex cases.
- Ensures patient notifications are provided and documented in a timely manner for compliance: Important Medicare Letters (IML), Medicare Outpatient Observation Notice (MOON), Patient Choice, and Beneficiary Notice Letter (BNL).
- Ensures primary care physician identification and scheduling of follow-up PCP and specialist appointments for post[1]hospital follow up care.
- Maintains clinical competency and current knowledge of community resources, post-acute care providers and payor requirements to perform job responsibilities.
- Associate of Science degree in Nursing (ASN)
- Current valid license as a Registered Nurse in the state of Florida
- Two (2) years of medical/hospital nursing experience
- Bachelor of Science degree in Nursing (BSN)
- Health-related Master's degree or MSN
- Prior Care Management/Utilization Management experience
- ACM/CCM Certification
- Knowledge of community resources and post-acute care programs across the continuum
- Knowledge of clinical and social factors that affect the patient's functional status at discharge
- Knowledge of CMS Conditions of Participation for Discharge Planning
