Case Manager RN - Tallahassee
16 hours ago
Job description
Tittle:
Case Manager RN
Location:
Tallahassee, FL
Shift:
Evening shift
Duration:
Full time / Permanent role
Sign on Bonus:
$10,000
Relocation Assistance:
Case by case basis
Shift Differentials:
Evening Shift - $2.50 Weekend Shift - $2.00
Job Summary and Qualifications
The RN CM Care Coordinator will facilitate the interdisciplinary plan of care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care, and resource management.
The RN CM Care Coordinator will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization.
The RN CM Care Coordinator will identify potential barriers to patient throughput and quality outcomes and will facilitate appropriate discharge plans.
ESSENTIAL FUNCTIONS:
Performs a comprehensive assessment of psychosocial and medical needs of assigned patients
Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the medical record; plan is communicated to appropriate clinical disciplines
Assumes a leadership role with the interdisciplinary team to manage care, through criteria driven processes, for the appropriate level of care, patient status and resource utilization
Conducts interdisciplinary team meetings to provide a mechanism for all clinical disciplines to collaborate, plan, implement, and assess the plan of car; patient selection should be criteria based and interventions will be documented
Evaluates admissions for medical necessity using approved criteria at defined intervals throughout the episode of care; escalates medical necessity and admission status issues through the established chain of command
Evaluates and assess observation patients for appropriateness in observation status
Performs utilization management reviews and communicates information to third party payors
Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies
Demonstrates knowledge of regulatory requirements, facility ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services
Makes appropriate referrals to third party payer disease and case management programs for recurring patients and patients with chronic disease states
Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team
Facilitates patient throughput with an ongoing focus on quality and efficiency
Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems
Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals
Assesses patients' post discharge needs and facilitates the provision of services necessary to meet identified needs
Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered
Identifies patients with the potential for high risk complications and makes appropriate referrals acting as an advocate for the individual's healthcare needs
Directs activities to identify and provide for the needs of the under resourced patient population to include patient education activities, patient assistance programs, and community based resources
Develops individual plans of care for recurring patients to include education on appropriately accessing healthcare resources, preventative education, and community based resources
Assumes a leadership role in the development, revision, and implementation of clinical protocols which transition patients across the continuum of care or discharge patients to an appropriate service level of care
Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely
Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered.
Qualifications:
Candidates are required to have a minimum of 3 years of RECENT (Within the last year) Case Manager experience in an acute care setting.
Also open to candidates with 3 years of experience on the following units: Med/Surg, Tele, Neuro, ICU, PCU, or ED.
will also consider candidates with Case manager experience in home health or insurance.For home health and insurance, they must have 3 years of acute care experience total and must have at least 1 year of acute care experience within the last 5 years.
Associate's degree in nursing or Diploma in Nursing requiredBachelor's degree in nursing preferred
Current FL RN license required or appropriate compact licensure. If compact license held, active FL RN licenserequiredwithin90 days of hire
Advanced Practice Registered Nurse license is acceptable for position if current and compliant
Certification in Case Management, Nursing, or Utilization Review, preferred
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