RN Case Manager
6 days ago
NCH Healthcare System is a leading provider of comprehensive care in Southwest Florida, delivering high-quality healthcare services to our community.
We are committed to transforming healthcare through innovation, collaboration, and a patient-centered approach.
Job SummaryThe RN Case Manager serves as a patient advocate, supporting and guiding patients, families, and caregivers through their healthcare journey.
This role is responsible for participating in the development of the patient's plan of care, ensuring efficient throughput, and facilitating safe and appropriate discharge plans.
Key Responsibilities- Screen patients for clinical, psychosocial, financial, and other factors that may affect care progression and collaborate with patients/families/caregivers in goal setting.
- Evaluate the patient's/family's/caregiver's level of understanding and engagement with the progress toward goals and incorporate findings into the plan of care.
- Arrange services among community agencies, providers, patients/families/caregivers, and others involved in the plan of care.
- Provide patients/families/caregivers with available tools/resources, including pertinent quality measures, to make informed choices.
- Develop a plan that is clinically appropriate and focused on the patient's care needs and goals for care and treatment.
- Facilitate bi-directional communication to enhance the handover of care from one setting and arrange/ensure all elements of the transition plan are implemented and communicated to key stakeholders.
- Identify available community resources/potential partners and advocate for resolution of gaps in the available resources and processes.
- Maintain knowledge of and ensure compliance with federal, state, local, and organization accreditation requirements that impact their scope of services and ability to advocate for the patient.
- Ensure the patient is in the appropriate status, level of care, and length of stay for the patient's clinical condition and participate in multidisciplinary rounds with the care team.
- Follow through with appropriate intervention and documentation to facilitate discharge when a patient fails to meet medical necessity.
- Identify and address avoidable delay practice patterns that may require modification to support cost-effective care.
- Educate patients/families/caregivers on the financial impact of their care options.
- Track avoidable delays/days as well as over/under utilization of resources.
- Provide the clinical information necessary for the appeals process of cases for which a denial of care or services has been received.
- Proactively prevent medical necessity denials by providing education to physicians, staff, and patients, interfacing with payers, and documenting relevant information.
- Participate in the development of performance improvement activities relevant to identified opportunities.
- Actively collaborate with utilization review team to facilitate and meet organizational and department goals.
- Recognize situations that require referral to quality or risk management and make a timely referral.
- Minimum of Associate Degree in Nursing required; BSN preferred.
- Minimum of 1 year Discharge planning, case management, managed care, or Registered Nurse experience in a medical setting.
- Licensed as a Registered Nurse (RN) in the state of Florida.
- Basic Life Support (BLS) certification required from the American Red Cross or American Heart Association.
- Case Management Certification preferred.
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