The RN Care Manager, as part of an interdisciplinary team, including physicians, & payers, ensures that the patients progression through the acute episode of care (admission to post discharge) is quality driven, while being efficient and cost effective.
The RN Care Manager works with the attending and consulting physicians to facilitate effective and efficient transition through the process of hospitalization. The RN Care Manager works collaboratively with all members of the inter disciplinary team to ensure patient needs are met, and care delivery is coordinated across the continuum, as well as appropriately reimbursed by payers as contracted. The RN Care Manager seeks the expertise of social workers to resolve psychosocial/financial patient care issues and to develop and implement complex patient transition/discharge plans as needed. The incumbent interacts with patients, family members, healthcare professionals, community, and state agencies in this effort. The RN Care Manager serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information. The RN Care Manager is responsible for maintaining hospital compliance with regulatory bodies (e.g., CMS, PRO), as appropriate to their role and scope of responsibilities. The RN Care Manager is knowledgeable of third party payer requirements, utilizes medical necessity criteria as a tool to assess appropriateness of level and setting of care, assists in the denial and appeals process, assesses quality and identifies and reports potential risk management issues. The incumbent performs duties and tasks in accordance with performance standards established for the job. The incumbent is responsible for participation in patient safety, performance improvement initiatives appropriate to the position. The incumbent conducts all job responsibilities according to the Mission and Values of the Hospital and organization. The RN Care Manager reports to the Director of Care Management. SKILLS AND ABILITIES: Demonstrates the ability to work independently. Demonstrates excellent verbal and written communication skills, critical thinking and problem solving skills, and the ability to prioritize well. Demonstrates the ability to act in an autonomous, self directed manner. Demonstrates the ability to receive stimuli from multiple sources simultaneously. Demonstrates organization and delegation skills, negotiation and conflict resolution skills, demonstrates flexibility, and is committed to the team concept. Demonstrates teamwork, initiative, and willingness to learn. Accepts and respects diversity without judgment, and possesses strong customer service values. EDUCATION AND/OR EXPERIENCE: Registered Nurse with a valid, unrestricted State license required. Bachelors degree in Nursing or related health field preferred. Three years of clinical or acute care experience; additional three to five years of experience required if nursing education not at the Bachelors degree. Certification in case management and or utilization review is required within three years of hire. Care management knowledge and experience, particularly across the continuum preferred. Payer case management, utilization management, or disease management experience preferred.* *Work hours are first shift w/ on-call weekends and holiday rotation* *