RN Case Manager

2 weeks ago

Norwalk, Connecticut, United States Norwalk Hospital Association Full time
Job Summary

We are seeking a highly skilled and experienced RN Case Manager to join our team at Norwalk Hospital Association. As a key member of our care coordination team, you will be responsible for providing direction and leadership to the clinical team regarding patient level of care and discharge transition plans.

Key Responsibilities
  • Coordinate and direct level of care appropriateness from admission and continuing throughout the entire stay, using discretion and independent judgment in applying appropriate initial screening criteria standards.
  • Prioritize and delegate daily functions to assure completion of all required tasks, including coordinating ambulance and DME.
  • Complete planning using high-risk admission data and discharge criteria, anticipating medical/psychosocial needs in high-risk patients.
  • Manage level of care status throughout stay by performing continued stay reviews, removing barriers to progression of care, and revising transition plans as needed.
  • Ensure all appropriate regulatory documents are provided to the patient, including MOON, CT notice, IMM, HINN, and ABN.
  • Ensure the completion of a discharge needs assessment and formulation of a plan on all admissions, using appropriate resources such as CARL tool for bundled payment cases and Navihealth.
  • Act as a clinical role model to the healthcare team, leading and facilitating multidisciplinary rounds to proactively progress the patient's plan of care and discharge.
  • Address readmission prevention strategies and LOS concerns, querying members of the healthcare team to obtain accurate and complete documentation to ensure appropriate clinical documentation to support level of care.
  • Coordinate and collaborate to assure the implementation of all discharge plans, meeting and acting on cases not meeting admission criteria, and referring to physician advisors all cases requiring immediate review and/or discussion.
  • Proactively interact with third-party payers to prevent denials, acting as liaison between patient, physician, family, and healthcare team regarding plan of care and progress towards goals.
  • Provide education to physicians, nurses, and other members of the healthcare team, providing a concise hand-off to colleagues daily.
  • Track and trend variance data, elevating concerns/findings to management, complying with all standards and policies regarding safety/patient safety initiatives, and fulfilling all compliance responsibilities related to the position.
Requirements
  • Minimum formal education of Associate Degree in Nursing and minimum of three years job-related experience.
  • Registered Nurse license State of CT with minimum of one year as an acute Care Coordinator.
  • Knowledge and expertise with use of electronic medical record and use of both Interqual and Milliman screening criteria.
  • Excellent collaborator and team member who is able to work closely with physicians and all members of the healthcare team to procure the right level of care, correct order for hospitalization, optimal plan of care, and facilitation of services.
  • Knowledge and expertise in both CMS and insurance industry standards as well as guidelines pertaining to appropriate coverage notifications.
  • Ability to be flexible, resourceful, and creative in problem-solving, with excellent communication skills both oral and written.

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