RN Case Manager

2 weeks ago

Manchester, United States Catholic Medical Center Full time
RN Case Manager (Full-Time Days) - Case Management

Who You Are:

CMC is seeking a highly organized and detail-oriented professional with a strong commitment to ensuring quality patient care and efficient resource utilization. You are skilled in coordinating all aspects of patient care, serving as a liaison with insurance providers and care representatives to ensure compliance with payer and federal regulations. Your ability to collaborate effectively with the healthcare team supports seamless care transitions and promotes satisfaction among patients, families, staff, and physicians. With a focus on evaluation and continuity of care, you thrive in a role where you can facilitate optimal clinical outcomes and cost-effective care delivery through systematic and patient-centered approaches.

What You'll Do:
  • Collaborates and participates with the primary nurse, social worker, and the multidisciplinary team in the ongoing clinical assessment of patient status and care management.
  • Identifies patients' care coordination needs by performing a clinical review of the patient's medical record, and discussion of the plan of care with the attending Physician and other members of the Healthcare Team.
  • Assists with identification of patients who care in need of complex care coordination and may have barriers to discharge in a timely fashion to prevent any delays and ensure patients' needs will be met.
  • Monitors patient's progress to ensure care is appropriate and timely.
  • Assists the Healthcare Team in the coordination of care on the unit by serving as a resource to staff in day to day clinically based problem resolution.
  • Participates in daily unit clinical/discharge planning rounds and monitors compliance with the advanced directive process.
  • Reviews patient admission orders, clinical status, and treatment plan within 24 hours and determines patient's appropriate level of care against McKesson's Interqual criteria
  • Provides third party payors with concurrent review information as needed to comply with payors' requirements for documentation of medical necessity and negotiates resolution of any disagreement over the need for services.
  • Intervenes with appropriate individuals/departments regarding delays in service that may have an impact on quality of patient care and/or length of stay.
  • Interprets federal and state regulations pertaining to coverage issues and provides education to patient and family. Issues non-coverage notices in compliance with Medicare and Medicaid guidelines.
  • Participates as part of the interdisciplinary team in the development or revision of hospital policies /procedures pertaining to patient care processes.
  • Assist in the identification of organizational priorities for improvement.
  • Identifies and collects clinical data in support of quality, risk management, utilization, infection control and resource utilization etc.
  • Performs initial chart review for all patients for early identification of discharge planning needs and facilitates planning in collaboration with the interdisciplinary team, patient and family.
  • Monitors patient status to identify appropriate level of care based on established guidelines in a timely fashion to ensure an optimal discharge plan.


Qualifications

What You'll Bring:
  • Bachelor's Degree in Nursing preferred.
  • Minimum of two years' experience in case management and/or utilization management preferred, or relevant professional experience.
  • Three years clinical experience required.
  • Current registration in the State of NH as a Registered Nurse.
Who we are:

Catholic Medical Center ("CMC") is a nonprofit, regional health system committed to delivering the highest quality and most advanced healthcare to patients across New Hampshire. CMC is the home of the nationally-renowned New England Heart & Vascular Institute, rated among the top cardiovascular programs in the country. We are driven by our mission to offer health, healing, and hope to every individual who seeks our care, and we live by our values of Respect, Integrity, Compassion, and Commitment. CMC is proud to be named to the Forbes list of America's Best-in-State Employers for two consecutive years. This prestigious award is presented by Forbes and Statista, Inc., and is based on 2.1 million employer recommendations from employees working for companies with more than 500 employees in the United States. With our award-winning clinical programs, primary care network and dedication to community, CMC is fostering a healthier New Hampshire, every day.

Catholic Medical Center is an equal opportunity employer and we embrace diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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