RN-Hospital Care Manager
4 weeks ago
Hospital Care Manager Job Summary
The Hospital Care Manager plays a vital role in the care team, focusing on patient engagement and activation. This position is responsible for patients' care transition out of the acute care setting and positively impacts longitudinal care plan alignment.
In collaboration with physicians, the Hospital Care Manager leads the multidisciplinary team, including clinical staff and payors, to ensure efficient delivery of quality, cost-effective care.
The Hospital Care Manager leads the team for each patient individually, with the goal of maximizing autonomy where possible.
Key Accountabilities
- Partners with attending providers throughout hospitalization to promote effective and efficient utilization of clinical resources, ensuring quality, cost-effective care.
- Anticipate next steps and facilitate communication to maximize care efficiencies for the patient and family.
- Identifies social determinants of health that increase the patient's risk for negative outcomes.
- Ensures clear documentation for the interdisciplinary care team and coordinates post-acute plans with the ambulatory care management team as appropriate.
- Facilitates patient access to resources and relevant services.
- Addresses and resolves system problems impeding diagnostic or treatment progress.
- Navigates value-based care with expertise and ensures longitudinal plan is patient-focused and aligns with patient and caregiver goals.
- Assesses patients' and family's psychosocial risk factors through evaluation of prior functioning levels, appropriateness, and adequacy of support systems, reaction to illness, and ability to cope.
- Maintains expert-level knowledge of body systems and expected clinical outcomes for patient disease process.
- Maintains current knowledge of changes in state and federal regulatory requirements related to the provision of care management services in an acute care setting.
- Ensures medical necessity, appropriate level of care, and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan.
- Navigates the team through complex compliance, regulatory, and insurance requirements.
- Coordinates with third-party payors on a regular basis.
- Serves as a resource for patients and families with regard to their rights and responsibilities, when payment of care is denied or when care is no longer medically necessary.
- Advocates for patient and family empowerment and independence to make autonomous healthcare decisions and access needed services within the healthcare system.
Minimum Qualifications
- Education - Bachelor's degree in nursing
- Experience - Three (3) years acute care nursing experience. One (1) year acute care/case management experience preferred.
- Required Licensure - Licensed to practice as a Registered Nurse in South Carolina
- Other Required Skills/Experience - Accredited Case Manager (ACM) or Certified Case Manager (CCM) is preferred. Knowledge of Medical Necessity Criteria is preferred.
Prisma Health
Our vision is simple: to transform healthcare for the benefits of the communities we serve.
The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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