Case Manager RN PRN

2 weeks ago


Smyrna, Georgia, United States TriStar StoneCrest Full time
Job Summary

We are seeking a skilled Registered Nurse Case Manager to join our team at TriStar StoneCrest Medical Center. As a Case Manager RN, you will play a vital role in promoting patient-centered care by coordinating the plan of care for patient stays, managing length of stay, ensuring appropriate resource management, and developing a safe and appropriate discharge plan in collaboration with the multidisciplinary team.

Responsibilities
  • Identify patients at risk for adverse outcomes during transition from one level of care/setting to another.
  • Perform comprehensive assessment of psychosocial, medical, and discharge needs of patients/family, along with assessment of resources appropriate and available to the patient/family.
  • Reassess patient's clinical condition as indicated, considering patient's readmission status or risk of readmission and develop strategies to mitigate, including education on accessing healthcare resources, preventative education, and community-based resources.
  • Coordinate plan of care and drive discharge plan by collaborating with multidisciplinary healthcare team and patient's physician to facilitate successful care transition.
  • Partner with Social Services to ensure post-acute medical needs and level of care are appropriate.
  • Assume responsibility for timely referral to Social Services when risk factors for psychosocial determinants of health are identified.
  • Involves patient and family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals.
  • Evaluate progression of care using evidence-based tools and approved criteria (InterQual) throughout episode of care; escalate progression and transition of care issues through established chain of command.
  • Make appropriate referrals to third-party payer and disease and case management programs for recurring patients and patients with chronic disease states.
  • Facilitate patient throughput with ongoing focus on effective care transition, quality, and efficiency.
  • Document professional recommendations, discharge plan, care coordination interventions, and case management activities to effectively communicate to all members of healthcare team.
  • Align patient needs with available resources to ensure safe discharge/transition.
  • Act as liaison through effective and professional communications between and with physicians, patient/family, hospital staff, and outside agencies.
  • Actively seek ways to control costs without compromising patient safety, quality of care, or services delivered.
  • Direct activities to identify and provide for needs of under-resourced patient population, including patient education activities, patient assistance programs, and community-based resources.
  • Participate in performance improvement activities, including identifying, documenting, and intervening when avoidable days occur.
  • Adhere to established policy and procedure and standards of care; escalate issues promptly through established chain of command.
  • Demonstrate knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives.
Requirements
  • Currently licensed as a Registered Nurse in state(s) of practice according to law and regulation.
  • Associate Degree in Nursing or Nursing Diploma.
  • 2+ years experience in case management or 3+ years experience in clinical nursing.
  • InterQual experience.

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