Registered Nurse (RN) - Case Management
Grand View Hospital
Sellersville, PA

Registered Nurse, RN, Case Manager

Responsibilities The Registered Nurse, RN, Case Manager is responsible for the overall coordination of care for an assigned case load. Concurrent and retrospective clinical review of inpatient medical records to evaluate the utilization of acute care services. Specific reviews are determined both internally and by requirements/requests of external payers or regulatory agencies and play a significant role in obtaining reimbursement for acute care services. The goal of the Registered Nurse, RN, Case Manager is to collaborate with patients, families and health care providers to promote health and manage illness. The Registered Nurse, RN, Case Manager facilitates the use of assessment, coordination and education to achieve quality patient care outcomes while coordinating Interdisciplinary comprehensive and cost effective care across the Continuum. Essential Functions: * Advocate for the patient by expediting post-acute placement and/or discharge logistics. * Confirm receipt of electronic referral for discharge logistics (DME, home health, hospice, transportation, post-acute placement, etc.) * Obtains and processes activities that prepare for post-acute transition such as completing necessary forms, authorizations, reports, patient signatures, and requisitions as needed. * Partner with the interdisciplinary team to implement post-acute placement for SNF, rehab, sub-acute, assisted living facility or other discharge logistics as ordered. * Confirm patients' benefits, identify preferred providers, and use knowledge of community availability to affect timely disposition. * Confer with case management to prioritize discharge requests. * Complete and transmit necessary forms to facilitate placement of patient. * Use electronic software to distribute post-acute placement requests to regional resources and identify availability. * Establish and maintain routine communication with referring interdisciplinary team to keep them informed of the progress of their request. * Identify any obstacles to timely transition and collaborate with the case manager to resolve the issue. Record avoidable days in the electronic software as it applies. * Document placement in the electronic software as it applies. * In collaboration with the requesting clinician, arrange safe transportation that best fits the patient's needs and financial resources. * Update all involved parties regarding progress, revisions and other information related to implementing the plan. * Report any quality issues encountered with preferred providers that require follow-up. * Facilitate prompt processing of all requests for post-acute services including durable medical equipment (DME), or appointments with community resources. * Collaborate with the patient and interdisciplinary team to coordinate follow-up appointments for patients with their primary care physician and/or specialist provider. * Document appropriate referrals and/or appointments in the electronic medical record prior to discharge. * Resolve any pre-certification, registration, or form completion prior to setting up an appointment with a community provider. * Participate in follow-up processes to discharged patients to query about quality and timeliness of post-acute arrangements. * Demonstrate independent problem-solving skills on behalf of the case management team and the patient. * Professionally respond to payer's request for information. Utilization Review and Departmental Support Activities * Review in-house observation patients and provide the Medicare Outpatient Observation Notice (MOON). Document completion in the electronic software as it applies. * Review anticipated discharges and provide appropriate Medicare patients with the Important Message from Medicare (IMM) follow-up notice. Document completion in the electronic software as it applies. * Escalate any patient questions regarding the MOON and/or IMM timely to the care coordinator and/or utilization review nurse. * Support and assist with clerical duties as needed within the department by: o Receiving and relaying messages to/from the care management team to other areas in the hospital and community and providing information whenever possible to reduce interruptions. * Report sentinel events and quality of care issues to the department leadership team. * Collect and track data as determined. * Participate in performance improvement activities as indicated. * Articulate the organization and program mission and goals. * Demonstrate the ability to effectively manage time. * Attend and participate in daily huddles and monthly departmental meetings. * Demonstrate knowledge of and adhere to all organization and department policies and/or procedures. * Promote program stability, reputation, and growth by coordinating positive teamwork with colleagues. * Appropriately receive constructive guidance from senior staff and/or leadership. * Preserve the basic human rights of expression, decision, action, confidentiality and personal dignity for all patients and families. * Respect the cultural diversity of all patients, families, and employees. * Demonstrate effective team building activities. * Demonstrates mature negotiation and conflict management strategies and skills. * Demonstrates effective use of critical thinking skills to independently solve problems. * Demonstrate knowledge of current regulatory and accrediting agency requirements as it pertains to obtaining services for patients. Qualifications Education and Experience: Associate's Degree Nursing, required Bachelor's Degree in Nursing, preferred Needs knowledge of: Utilization Review, Case Management, DC Planning, Care Coordination, Precertification of hospital days and post-acute care services. Prefer 3- 5 years of acute care hospital experience and 2 years of Acute Care Case Management experience. Licenses and Certifications: Registered Nurse in PA - Licensed, Upon hire, required Benefits: We offer a competitive salary and comprehensive benefits to part-time and full-time employees including: * Medical, dental, & vision insurance available 1st of the month after start date * Wellness and gym discounts & free cardiac rehab gym * 403B * On-site discounted childcare center * Paid time off * Sick time for full time employees * Tuition assistance * Free life insurance for full time employees * Long term disability for full time employees * Short term disability * Employee referral bonus * Identity theft insurance * Pet Insurance * Flexible spending accounts * Employee discount program * Employee Assistance Program * Free parking Responsibilities The Registered Nurse, RN, Case Manager is responsible for the overall coordination of care for an assigned case load. Concurrent and retrospective clinical review of inpatient medical records to evaluate the utilization of acute care services. Specific reviews are determined both internally and by requirements/requests of external payers or regulatory agencies and play a significant role in obtaining reimbursement for acute care services. The goal of the Registered Nurse, RN, Case Manager is to collaborate with patients, families and health care providers to promote health and manage illness. The Registered Nurse, RN, Case Manager facilitates the use of assessment, coordination and education to achieve quality patient care outcomes while coordinating Interdisciplinary comprehensive and cost effective care across the Continuum. Essential Functions: * Advocate for the patient by expediting post-acute placement and/or discharge logistics. * Confirm receipt of electronic referral for discharge logistics (DME, home health, hospice, transportation, post-acute placement, etc.) * Obtains and processes activities that prepare for post-acute transition such as completing necessary forms, authorizations, reports, patient signatures, and requisitions as needed. * Partner with the interdisciplinary team to implement post-acute placement for SNF, rehab, sub-acute, assisted living facility or other discharge logistics as ordered. * Confirm patients' benefits, identify preferred providers, and use knowledge of community availability to affect timely disposition. * Confer with case management to prioritize discharge requests. * Complete and transmit necessary forms to facilitate placement of patient. * Use electronic software to distribute post-acute placement requests to regional resources and identify availability. * Establish and maintain routine communication with referring interdisciplinary team to keep them informed of the progress of their request. * Identify any obstacles to timely transition and collaborate with the case manager to resolve the issue. Record avoidable days in the electronic software as it applies. * Document placement in the electronic software as it applies. * In collaboration with the requesting clinician, arrange safe transportation that best fits the patient's needs and financial resources. * Update all involved parties regarding progress, revisions and other information related to implementing the plan. * Report any quality issues encountered with preferred providers that require follow-up. * Facilitate prompt processing of all requests for post-acute services including durable medical equipment (DME), or appointments with community resources. * Collaborate with the patient and interdisciplinary team to coordinate follow-up appointments for patients with their primary care physician and/or specialist provider. * Document appropriate referrals and/or appointments in the electronic medical record prior to discharge. * Resolve any pre-certification, registration, or form completion prior to setting up an appointment with a community provider. * Participate in follow-up processes to discharged patients to query about quality and timeliness of post-acute arrangements. * Demonstrate independent problem-solving skills on behalf of the case management team and the patient. * Professionally respond to payer's request for information. Utilization Review and Departmental Support Activities * Review in-house observation patients and provide the Medicare Outpatient Observation Notice (MOON). Document completion in the electronic software as it applies. * Review anticipated discharges and provide appropriate Medicare patients with the Important Message from Medicare (IMM) follow-up notice. Document completion in the electronic software as it applies. * Escalate any patient questions regarding the MOON and/or IMM timely to the care coordinator and/or utilization review nurse. * Support and assist with clerical duties as needed within the department by: o Receiving and relaying messages to/from the care management team to other areas in the hospital and community and providing information whenever possible to reduce interruptions. * Report sentinel events and quality of care issues to the department leadership team. * Collect and track data as determined. * Participate in performance improvement activities as indicated. * Articulate the organization and program mission and goals. * Demonstrate the ability to effectively manage time. * Attend and participate in daily huddles and monthly departmental meetings. * Demonstrate knowledge of and adhere to all organization and department policies and/or procedures. * Promote program stability, reputation, and growth by coordinating positive teamwork with colleagues. * Appropriately receive constructive guidance from senior staff and/or leadership. * Preserve the basic human rights of expression, decision, action, confidentiality and personal dignity for all patients and families. * Respect the cultural diversity of all patients, families, and employees. * Demonstrate effective team building activities. * Demonstrates mature negotiation and conflict management strategies and skills. * Demonstrates effective use of critical thinking skills to independently solve problems. * Demonstrate knowledge of current regulatory and accrediting agency requirements as it pertains to obtaining services for patients. Qualifications Education and Experience: Associate's Degree Nursing, required Bachelor's Degree in Nursing, preferred Needs knowledge of: Utilization Review, Case Management, DC Planning, Care Coordination, Precertification of hospital days and post-acute care services. Prefer 3- 5 years of acute care hospital experience and 2 years of Acute Care Case Management experience. Licenses and Certifications: Registered Nurse in PA - Licensed, Upon hire, required Benefits: We offer a competitive salary and comprehensive benefits to part-time and full-time employees including: * Medical, dental, & vision insurance available 1st of the month after start date * Wellness and gym discounts & free cardiac rehab gym * 403B * On-site discounted childcare center * Paid time off * Sick time for full time employees * Tuition assistance * Free life insurance for full time employees * Long term disability for full time employees * Short term disability * Employee referral bonus * Identity theft insurance * Pet Insurance * Flexible spending accounts * Employee discount program * Employee Assistance Program * Free parking