Registered Nurse (RN) - Case Manager - Anderson

RN Care Manager

The RN Care Manager is responsible for providing coordination of care for patients to support safe, seamless, timely transitions across the continuum. This role utilizes a collaborative process, the RN Care Manager identifies, assesses, plans, implements and evaluates the options and services required to meet an individual’s health and health related needs, including social- determinants that affect one’s overall wellbeing. The RN Care Manager is responsible for screening, identification, and assessment of individuals in need of active Case Management services and promotes the right resources, at the right time and at the right place.

Essential Job Functions

• Identifies and prioritizes patients in need of care management services, using a holistic approach inclusive of biopsychosocial, functional, cultural, spiritual, and financial factors. Plans with the patient, caregivers and members of the healthcare team to maximize health care responses, quality and cost-effective outcomes. Monitors and revises the plan as indicated when patient condition changes.
• Completes all necessary documentation. Maintains, clear, concise, and timely documentation in the patient record to reflect the needs of the patients. Handovers are expected to be utilized at points of level of care change, staff change, as well as care transitions.
• Documentation will reflect plan of care to address post hospital care needs and resources and evidence of patient, family or caregiver involvement in planning. Ensuring patient’s and caregiver’s treatment goals and preferences are incorporated into the transition of care planning and communicated to the multidisciplinary team.
• Follow standardized practices and process related to Advance Care Planning, Length of Stay management and readmission prevention.
• Supports denial prevention related to medical necessity through addressing/removing barriers to progression of care and participating in Interdisciplinary Discharge Rounds.
• Supports and promotes assertive, proactive care for patients, assisting in removing barriers related to achieving timely testing and treatment. Ensures resources are utilized appropriately and offering alternatives to acute care to the care team.
• Works in collaboration with revenue cycle partners to help remove barriers to ensure patients are in the appropriate classification as guided by the physician.
• Works in conjunction with patient access to ensure all regulatory letters are delivered to the patient in a timely manner.
• Participates in department clinical outcome projects as well as process improvement initiatives within the care management department.
• Works collaboratively with peers to achieve facility and department goals and daily work as evidenced by appropriate and timely communication which is respectful and clear.
• Shares responsibilities, promoting team based approach to accomplish work.
• Strong collaborative partnerships with other members of the care team.
• Supports and follows compliance rules and regulation as mandated by CMS and Conditions of Participation for discharge planning and utilization management. Addresses opportunities or potential concerns with leadership.

Stays abreast of community resources available to facilitate safe patient transitions of care and remains current on clinical advancements related to primary patient population. This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Licensing/Certification

BLS Basic Life Support – American Heart Association (required)

RN License in the state in which they are working or covered by compact (required)

Accredited Case Manager Certification (ACM) from American Case Management Association or Certified Case Manager (CCM) from Commission for Case Manager Certification or American Nurses Credentialing Center (ANCC) Nursing Case Management board certification (preferred)

Education

Bachelor of Science in Nursing (preferred for BSMH, required for RSFH)

Work Experience

1 year of experience in clinical setting (required)

3 years of experience in an acute care clinical setting (preferred)

Ambulatory or post-acute, care coordination experience (preferred)

Patient Population

Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.

Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient’s status and interprets the appropriate information needed to identify each patient’s requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures.

Neonates (0-4 weeks)

Infant (1-12 months)

Pediatrics (1-12 years)

Adolescents (13-17 years)

Adults (18-64 years)

Geriatrics (65 years and older)

Working Conditions

Periods of high stress and fluctuating workloads may occur.

General office environment.

May be exposed to high noise levels and bright lights.

May be exposed to physical altercations and verbal abuse.

May be exposed to limited hazardous substances or body fluids.

May be required to use physical restraints.

May be exposed to human blood and other potentially infectious materials.

May be exposed to adverse weather conditions; cold, hot, dust, wind, etc.

May have periods of constant interruptions.

Required to car travel to off-site locations, occasionally in adverse weather conditions.

Prolonged periods of working alone.

Physical Requirements

Physical Demands

Frequency 0% 1-33% 34-66% 67-100%

Lifting/Carrying (0-50 lbs) X

Lifting/Carrying (50-100 lbs) X

Push/Pull (0-50 lbs) X

Push/Pull (50-100 lbs) X

Stoop, Kneel X

Crawling X

Climbing X

Balance X

Bending X

Work Position

Frequency 0% 1-33% 34-66% 67-100%

Sitting X

Walking X

Standing X

Additional Physical Requirements/Hazards

Physical Requirements

Manual dexterity (eye/hand coordination)

Perform shift work

Hear alarms/telephone/audio recordings

Finger Dexterity

Acuity – near

Hazards

Use of Latex products

Skills

Hard/Tech/Clinical Skills: Care management, Discharge planning, Patient Advocacy, Flexible, Care Planning, Care Coordination, Analyzing data or information, Reimbursement methodologies, Staffing workflow and bed allocation, Clinical knowledge, Tracking, Working knowledge of local and state resources, Knowledge of government and non-government payor practices, regulations, standards and reimbursement

Soft/Interpersonal Skills: Knowledge Sharing, Attention to detail, Critical thinking, Communication with family members, Conflict resolution, Proactive, Problem Solving, Active listening, Relationship building, Effective problem solving, Teamwork, Facilitation

Mercy Health is an equal opportunity employer.

As a Mercy Health associate, you’re part of a mission that matters. We support your well-being – personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.

What we offer

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible) • Medical, dental, vision, prescription coverage, HAS/FSA options, life insurance, mental health resources and discounts • Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders • Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status.