Registered Nurse - Case Manager (RN)

1w1 week ago

WVU Medicine

US · Full-time · $72,000 – $88,000

About this role

This position comprehensively plans for targeted patient populations, performing resource management including denial management, utilization management, and access to the appropriate level of care. The role also encompasses discharge planning, care facilitation, and referral to other levels of care.

Day-to-day responsibilities include managing all aspects of transition and discharge planning for assigned patients in a timely manner. The nurse collaborates with the multidisciplinary care team to facilitate the discharge process and monitors patient progress, intervening as necessary to ensure the plan of care is patient focused, high quality, efficient, and cost effective.

Working closely with physicians, staff, patients, and families, the case manager provides education to ensure effective transition planning. They meet directly with patients and families to assess needs and develop individualized discharge plans, communicating complex family dynamics that may impact care.

This role offers the opportunity to apply clinical expertise in a collaborative environment, contributing to optimal patient outcomes across the continuum of care. The nurse facilitates referrals to post-acute services and uses quality screens to identify potential issues such as avoidable delays and readmissions.

Requirements

Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
Three (3) years clinical experience.
Experience in discharge planning and care coordination across the care continuum.
Knowledge of post-acute care services, including homecare, hospice, skilled nursing, and rehab facilities.
Proficiency in documenting patient interactions and transition plans according to departmental policy.
Ability to apply utilization criteria and perform clinical reviews to assess medical necessity.

Responsibilities

Manages all aspects of transition/discharge planning for assigned patients in a timely manner.
Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload.
Monitors the patient’s progress, intervening as necessary to ensure the plan of care is patient focused, high quality, efficient, and cost effective.
Provides education as needed to staff, physicians, patients, and families to ensure effective transition planning.
Meets directly with patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team.
Initiates and facilitates referrals to post-acute services including homecare, durable medical equipment, hospice care, long term acute care facilities, acute rehab facilities, and skilled nursing facilities.
Completes clinical reviews for patients and applies approved utilization criteria to ensure medical necessity of admissions and continued stays.