BMC Case Manager Nurse

2 weeks ago


Martinsburg, West Virginia, United States WVU Medicine Full time
About the Role

We are seeking a highly skilled and experienced Nurse Case Manager to join our team at WVU Medicine. As a key member of our care management team, you will play a critical role in ensuring the smooth transition of patients from our hospital to their next level of care.

Key Responsibilities
  • Manage all aspects of transition/discharge planning for assigned patients in a timely and efficient manner.
  • Collaborate with the multidisciplinary team to facilitate the transition/discharge process for designated caseloads.
  • Monitor patient progress, intervening as necessary to ensure that plans of care and services provided are patient-focused, high-quality, efficient, and cost-effective.
  • Provide education and support to staff, physicians, and patients and their families to ensure effective transition planning.
  • Develop and implement individualized transition/discharge plans in collaboration with the physician team.
  • Communicate with the multidisciplinary team and post-acute providers regarding complex family dynamics that may impact patient care and transition/discharge planning.
  • Initiate and facilitate referrals to post-acute services, including home care, durable medical equipment, hospice care, and skilled nursing facilities.
  • Document all interactions with patients and families, as well as transition/discharge planning activities and progress, according to departmental policy.
  • Assist patients and families with completion of medical power of attorney, healthcare surrogate, and advanced directives.
  • Collaborate with patients and families to ensure appropriate resource and financial management, including financial assistance coordination and referrals.
  • Utilize quality screens in the electronic record to identify potential issues, including avoidable delays and readmissions.
  • Complete clinical reviews for patients and apply approved utilization criteria to ensure medical necessity of patient admissions and continued stays.
  • Screen for appropriate authorization and level of care, and facilitate covered day reimbursement certification for assigned patients.
  • Educate hospital staff and physicians on payer regulations and managed care principles to prevent denials.
  • Foster the integration of staff and students into the healthcare team.
Requirements
  • Current West Virginia licensure as a Registered Professional Nurse or licensure as a Registered Professional Nurse in another state with a temporary West Virginia practice permit.
  • Five (5) years of clinical experience.
  • Bachelor's degree in Nursing (BSN) preferred.
Working Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.



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