Nurse Care Manager

3 weeks ago

Greenville, South Carolina, United States Prisma Health Full time

About the Role

The Hospital Care Manager (HCM) plays a vital role in ensuring seamless patient care transitions from the acute care setting. This position is responsible for engaging patients and their families, leading the multidisciplinary team, and collaborating with physicians to deliver quality, cost-effective care.

Key Responsibilities

  • Partner with attending providers to promote efficient utilization of clinical resources, ensuring quality and cost-effective care.
  • Identify social determinants of health that increase patient risk for negative outcomes and coordinate post-acute plans with the ambulatory care management team.
  • Address and resolve system problems impeding diagnostic or treatment progress, proactively identifying and resolving delays and obstacles on behalf of the patient.
  • Navigate value-based care with expertise, ensuring longitudinal plans are patient-focused and align with patient and caregiver goals.
  • Assess patients' and family's psychosocial risk factors through evaluation of prior functioning levels, support systems, reaction to illness, and ability to cope.
  • Maintain expert-level knowledge of body systems and expected clinical outcomes for patient disease processes, as well as current knowledge of state and federal regulatory requirements.
  • Ensure medical necessity, appropriate level of care, and timely implementation of the plan of care in accordance with hospital Utilization Review Plan.
  • Navigate complex compliance, regulatory, and insurance requirements, coordinating with third-party payors on a regular basis.
  • Serve as a resource for patients and families regarding their rights and responsibilities, including delivery of regulatory documents as provided by CMS.
  • Advocate for patient and family empowerment and independence to make autonomous healthcare decisions and access needed services within the healthcare system.

Requirements

  • Education: Bachelor's degree in nursing
  • Experience: Three years of acute care nursing experience, with one year of acute care/case management experience preferred

Preferred Qualifications

  • Accredited Case Manager (ACM) or Certified Case Manager (CCM)
  • Knowledge of Medical Necessity Criteria

Work Environment

Variable (United States of America)

Location

Greenville Memorial Med Campus

Facility

1008 Greenville Memorial Hospital

Department

GMH Hospital Care Mgmt

About Prisma Health

Our vision is to transform healthcare for the benefit of the communities we serve. We are seeking talented individuals to join our team and contribute to this vision.

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