RN Case Manager

4 weeks ago


Norwalk, Connecticut, United States Nuvance Health Full time
Job Summary:

The Clinical Care Coordinator - RN Case Manager is responsible for providing direction and leadership to the clinical team regarding the patient level of care and discharge transition plan. This role acts as a principal liaison between emergency services, surgical services, nursing, finance, physicians, utilization review, and medical records to ensure appropriate status is assigned. The Clinical Care Coordinator - RN Case Manager assures patient progression of care is efficient and transition plans are executed to the appropriate level within the care continuum.

Responsibilities:

Coordinates and directs level of care appropriateness from admission and continuing throughout the entire stay.
Uses discretion and independent judgment in applying appropriate initial screening criteria standards as well as maintaining compliance with regulatory documents.
Prioritizes/delegates daily functions to assure completion of all required tasks, coordinating ambulance and DME.
Completes planning using high-risk admission data and discharge criteria, anticipating medical/psychosocial needs in high-risk patients.
Manages level of care status throughout stay by performing continued stay reviews, removing barriers to progression of care, and revising transition plans as needed.
Ensures all appropriate regulatory documents are provided to the patient, including MOON, CT notice, IMM, HINN, and ABN.
Ensures the completion of a discharge needs assessment as well as formulation of a plan on all admissions using appropriate resources, such as CARL tool for bundled payment cases and Navihealth.
Acts 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.
Addresses 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.
Coordinates/collaborates 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 interacts 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.
Provides education to physicians, nurses, and other members of the healthcare team, providing a concise hand-off to colleagues daily.
Tracks/trends variance data and elevates concerns/findings to management, complying with all standards and policies regarding safety/patient safety initiatives.
Fulfills all compliance responsibilities related to the position, performing other duties as assigned.

Requirements:

Associate Degree in Nursing
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, excellent communication skills both oral and written.
Certification in Case Management preferred or willing to obtain, Bachelor's Degree in Nursing preferred.
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