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RN Case Manager
2 months ago
Nuvance Health is seeking a skilled Clinical Care Coordinator to join our team in the Emergency Department. As a key member of our care coordination team, you will play a vital role in ensuring the seamless transition of patients through the healthcare system.
Key Responsibilities- Manage the Utilization Review process for patients requiring hospitalization, ensuring the correct level of care and optimal initial care plan.
- Make recommendations for Bed Request orders based on thorough review of available clinical information and evidence-based screening criteria.
- Refer cases to Physician Advisor review as necessary.
- Collaborate with Social Work Care Coordinators to develop optimal plans of care for discharge.
- Analyze clinical, financial, and social situations to identify problems and establish alternative courses of action.
- Perform rounding with ED team members to ensure appropriate case identification and planning discussions.
- Advise and educate patients and families on guidelines related to hospitalization and discharge planning.
- Issue required regulatory notices as necessary.
- Offer suggestions for improving performance and operations.
- Guide and direct the healthcare team to ensure optimal outcomes.
- Monitor ED throughput and assist in facilitating testing and procedures.
- Participate in community teams for managing complex and high-recidivist patients.
- Ensure transmission of information through accurate referrals for discharge/transition planning and handoff of pertinent information to Care Coordination colleagues.
- Collaborate with UR Specialist to complete transfer processes.
- Assist with audits and provide data for metric analysis.
- Comply with all pertinent standards, regulations, and guidelines.
- Fulfill all compliance responsibilities related to the position.
- Associate Degree in Nursing required; BSN preferred.
- Minimum three years of job-related experience, with at least one year as an acute Care Coordinator.
- Registered Nurse license in the State of CT required.
- Knowledge and expertise with electronic medical records and experience with Interqual and Milliman screening criteria.
- Excellent collaboration and teamwork skills, with ability to work closely with physicians and healthcare team members.
- Knowledge and expertise in CMS and insurance industry standards, as well as guidelines related to coverage notifications.
- Ability to be flexible, resourceful, and creative in problem-solving.
- Excellent communication skills, both oral and written.
- Certification in Case Management preferred or willingness to obtain.
