REGISTERED NURSE - CASE MANAGER

JOB RESPONSIBILITIES-

Registered Nurse - Case Manager

RN - CASE MGR

Full-Time

Registered Nurse candidates for the Case Manager opportunity will have the following job responsibilities:

• Conducts initial and ongoing assessment of each individual patient with respect to clinical condition, level of care, and plan of care.
• Reviews admission, pre-op orders for all components necessary for preadmission, admission process.
• Assist the physician offices in obtaining necessary assessments prior to surgery, procedures, and/or admission.
• Includes patient and family in care facilitation and education activities.
• Assist in the development and implementation of critical pathways.
• Utilizes computer support and physician advisor to determine potential outliers (length of stay and changes in condition) in continued hospital stay.
• Communicates the benefits and changes in the various benefit plans, both in the terms of health management and financial implications to physicians, , and patients and families as appropriate.
• Assists in management of payor denials; issues hospital-initiated notices of non-coverage (HINNs)
• Distinguishes between the levels of care available and interacts with the various benefit plans and their delivery systems to coordinate this care across the continuum.
• Defines desired clinical outcomes, sets target dates, and establishes a plan for required services and care, addressing all needs (i.e., physical, psycho-social, financial).
• Participates in IDT rounds,
• Conducts utilization review, evaluates clinical information, and communicates findings to physicians and payors on a timely basis in accordance with the NFRMC Utilization Review Plan and managed care contractual agreements.
• Submits clinical information to insurance companies to ensure all days are authorized and notifies director of continued stay denials.
• Applies decision support criteria (e.g. Interqual) appropriately.
• Maintains accurate, up-to-date documentation in MIDAS.
• Is cross-trained to function in any of the assigned Case Manager areas.
• Promotes close alignment with medical and ancillary staff to facilitate appropriate patient care delivery, including alternative level of care opportunities.
• Completes required documentation for transfer to next level of care. Coordinates with physician for optimal information related throughout the continuum.
• Assists with patient/family/significant others learning needs, abilities and readiness to learn. Identifies barriers to learning, such as language or culture. Integrates this information into the patients plan of care.
• Identifies and documents patient/family/SOs education needs in collaboration with other disciplines and implements an on-going education relevant to these needs.
• Documents patient teaching on appropriate teaching tool for each teaching episode.
• Ensures patient/family/SO understand discharge instructions

JOB QUALIFICATIONS-

Registered Nurse - Case Manager

RN - CASE MGR

Full-Time

• Registered Nurse candidates for the Case Manager opportunity must meet the following minimum job qualifications:
• Looking for 3 years of Recent (within the last year) experienced acute care Case Manager experience (If candidates do not have case manager experience, they would consider someone that has 2-3 years of ICU experience or strong Med-Surg experience)
• Must have good critical thinking skills. They need to know and understand the medical needs for patients
• Certification in Case Management, Nursing or Utilization Review is preferred
• Florida RN license and/or approved multistate RN license required. Compact license holders have 60 days to obtain the Florida license after relocation.
• BLS-AHA Provider issued card required within 30 days of start3 years of RN experience in an acute care setting is required
• Graduate of an accredited school of nursing as an RN. BSN preferred.