Nurse Care Manager
4 weeks ago
At St. Luke's Hospital, we are proud of the skills, experience, and compassion of our employees. Our employees are our most valuable asset, and individually and together, they are dedicated to satisfying the mission of our organization, which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses, and other healthcare providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for healthcare.
The RN Care Manager coordinates the overall progression of care, resource utilization, and discharge planning for designated patient populations across the continuum of care. This role works with providers, social workers, and multidisciplinary care teams to facilitate the achievement of desired patient, quality, and financial outcomes.
Key Responsibilities:
- Assesses the patient's needs, goals, and barriers in relation to the patient's clinical condition, psychosocial environment, and socioeconomic resources.
- Collaborates with the multidisciplinary team to plan, implement, and evaluate the patient's plan of care through rounding or other methods.
- Collaborates with the patient, family, or other caregivers, and multidisciplinary team to design a discharge plan respective of the patient's needs and goals.
- Re-evaluates and revises the discharge plan of care as additional information is obtained or goals change.
- Proactively considers options such as palliative care, home care, and other services that work to keep the patient as healthy as possible in the outpatient setting, minimizing the risk of re-admissions.
- Works as a team with other members of care management, including but not limited to: social workers, assistants, coordinators, utilization management staff, and director.
- Facilitates communication among all treatment team members.
- Manages length of stay by proactively identifying and mitigating issues and barriers to care and a successful discharge plan.
- Monitors risk assessment using available tools and implements discharge interventions accordingly, minimizing the risk of readmission.
- Identifies patients with an unplanned readmission and completes root cause analysis.
- Collaborates with Outpatient Care Managers to identify patients for handover and post-discharge follow-up.
Requirements:
- Registered Nurse with current licensure to practice in the State of Pennsylvania or seeking Pennsylvania licensure through reciprocity. NJ RN licensure required for Warren Campus.
- Advanced degree preferred. BSN preferred, MSN and/or Case Management Certification preferred.
- Extensive clinical knowledge. 3-5 years of acute care experience. Previous care management experience is preferred. Experience in the use of InterQual/Milliman criteria preferred.
- Basic computer skills required. Ability to establish and maintain collaborative and effective working relationships required.
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