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Employment Type:

Full time

Shift:

Day Shift

Description:

The RN Case Manager (RN CM), works in collaboration with a multidisciplinary team by identifying and initiating discharge planning to accomplish the timely transition of patients to a post-acute hospital setting and to ensure patients progress along the continuum of care. RN CM facilitates patient transitions efficiently and in a cost-effective manner that ensures quality outcomes. RN CM utilizes established guidelines to support appropriate level of care throughout hospitalization in compliance with CMS and organizational utilization management requirements. RN CM helps to ensure medical necessity is met by regularly reviewing severity of illness and intensity of service for patients to ensure appropriate and timely utilization of hospital services.

Essential Functions and Responsibilities

Uses approved criteria for admission and continued stay reviews to ensure appropriate setting and timely implementation of plan of care. Collaborates with admitting and/or attending physicians regarding appropriate level of care/status determination. Consults with Physician Advisor and administrative leadership as necessary for those patients not meeting medical necessary services for acute care. Effectively organizes and sets priorities on assignment caseload. Knowledgeable of Medicare, Medicaid and non-governmental payer regulations for patient care requirements. Timely completion of initial and concurrent reviews, to include OBS management. Completes biopsychosocial assessment of patients to determine post-acute needs. Implements safe discharge/treatment plans in a timely manner to prevent avoidable inpatient stays. Explores options with patient/family and appropriately assists in the decision-making process. Communicates discharge planning activities with interdisciplinary team daily through the maintenance of concurrent documentation and/or verbal report. Refers cases to home health, hospice, skilled nursing care facilities, DME companies, and other OP services and provides concurrent information as required. Assures response to and documentation of received referrals/consultation within 24 working hours. Is a patent advocate. Identifies community resources and maintains working relationships with referral agencies. Demonstrates service excellence by following HIPAA guidelines and meeting the Conditions of Participation set forth by the Center of Medicare and Medicaid Services (CMS). Identifies, processes, and documents CC44 accounts appropriately. Serves as a resource to the healthcare team. Evaluates hospitalized patients to ensure they are receiving services in the most appropriate and cost-effective level of care in collaboration with attending physicians and Physician Advisors. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participates in their resolution. Demonstrates self-directed learning. Maintains the confidentiality of information acquired pertaining to patients, physicians, employees, and visitors to Trinity Health facilities. Discusses patient and hospital information only among appropriate personnel in appropriately private places. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management. Behaves in accordance with the Mission, Vision, and Values of St. Mary’s Health System. Attends team huddles and meetings when working; if unable to attend then review of notes/minutes from meetings is required. Staff are accountable for knowing content of discussions. Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior.

OTHER FUNCTIONS AND RESPONSIBILITIES

_Performs other duties as assigned._

Professional Development

All Registered Nurses are expected to engage in professional role activities, including leadership, appropriate to their education and position. Registered nurses are accountable for their professional actions to themselves, their healthcare consumers, their peers and to society. The RN Case Manager is recognized as an expert in professional practice. The RN Case Manager is expected to contribute to the professional growth of others by acting as a preceptor, clinical coach, and mentor.

Required Education, Experience and Certification/Licensure

**Licensure/Certification/Registration:** Current GA RN license. Case Management Certification preferred. BLS required.

**Education:** Must be a graduate of an accredited school of nursing, BSN recommended.

**Experience:** Minimum 2 years' experience in nursing in a hospital setting; preferred 1 year in case management, utilization management, or discharge planning.

Required Skills and Abilities

Clinical and analytical skills necessary to facilitate collection of patient clinical information from medical record and to objectively apply various criteria as dictated by CMS. Strong organization and prioritization skills. Strong interpersonal and communication skills, including telephonic and electronic. Ability to concentrate and pay close attention to detail. Computer Skills:

+ Required: Basic keyboarding skills

+ Preferred:

+ EPIC

+ Microsoft Word

+ Microsoft Teams

+ Microsoft Outlook

+ Microsoft Excel

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran