Case Management Registered Nurse - Case Management, Full-Time

Knox Community Hospital; Mount Vernon (OH); On-site; USD 70,000 - 90,000; Full time

Job summary

Knox Community Hospital in Mount Vernon, OH is seeking a Case Management Registered Nurse to provide utilization management and discharge planning for ED and Nursing Care Units. You will determine admission appropriateness, coordinate care, and document progress in the medical record to support quality, cost-effective patient outcomes.

Responsibilities include initial and concurrent utilization reviews, identifying high‑risk patients, forming discharge plans, facilitating timely transitions, and

Qualifications

• BSN preferred and Ohio RN licensure required.
• AHA BLS certification required.
• Case management certification preferred.

Responsibilities

• Determine admission appropriateness and disposition for ED and units.
• Perform initial and concurrent utilization reviews.
• Identify high‑risk patients and coordinate discharge planning.
• Document progress in medical records and reports to payers.
• Promote communication between patient/family and care team.
• Assist in care coordination and adherence to policies.

Skills

Case management knowledge

Discharge planning

Utilization review

Communication skills

Education

BSN preferred

RN license Ohio

AHA BLS certification

Case management certification preferred

Job description

Case Management Registered Nurse - Case Management, Full-Time

Job Specifics

Case Management

Status

Full Time

Shift

Provides utilization management and discharge planning for patients presenting to Knox Community Hospital Emergency Department (ED) and/or Nursing Care Units. Utilizes approved criteria to determine appropriateness of patient admissions, observations, and continued stays. Assists in the provision of continuum of care for neonates, infants, pediatric, adult and geriatric patients. Collaborates and communicates with the healthcare team to help ensure quality patient care in a cost-effective timely manner. Documents accurately and in a timely manner. Provides timely clinical reviews, documents progress and/or completion in appropriate documentation system and to third party payers as indicated. Collects and reports departmental measures. Collaborates with the healthcare team to problem-solve patient difficulties in the Case Management arena. Adheres to organizational policies and procedures; regulatory/accrediting body requirements; and professional practice standards.

PRIMARY JOB RESPONSIBILITIES

• Determination of appropriateness for hospital level of care including designation as observation or inpatient for all planned admissions.
• Case screening and identification of high-risk patients and appropriate Case Management intervention based on patient need.
• Assess and assist in implementing discharge plans for patients requiring follow-up care.
• Performs and documents an initial and/or concurrent utilization review for all patients that will be admitted or placed in observation.
• Identifies and reports avoidable days and/or delays in care or services.
• Applies discharge screens to determine appropriateness of discharge for all patients.
• Provides patients and family members with relevant education and instructions.
• Actively promote communication between patient/family and the health care team to provide continuum of care and maximize outcomes.
• Documents case management activities in the progress notes of the patients' medical record.
• Utilizes the departmental standard format for organization of daily paperwork.
• Ensure that appropriate consults are in place to fully assess patient needs.
• Ensure use of clinical protocols, algorithms, teaching tools and preprinted orders if available and applicable.
• Develop working relationships with community health resources to improve outpatient access to health care for the ED population.
• Determines a working DRG in order to make critical decisions on the appropriate length of stay and resources consumed.
• Assists in the orientation of new personnel and students.
• Assumes responsibility and accountability for individual knowledge, skills performance and behavior in accordance with hospital, division and unit standards of care and policies and procedures.
• Utilizes measures to promote and maintain patient, visitor and personnel safety.
• Maintains patient, employee, physician and organization confidentiality; respects the rights, privacy and property of others.
• Demonstrates knowledge of disaster/emergency procedures and responds appropriately.
• Supports the mission, values and vision of the organization.

ADDITIONAL RESPONSIBILITIES

• Participates in mandatory in-services, staff meetings, educational programs, hospital committees and support groups.
• Presents a professional image.
• Demonstrates initiative in personal/professional development.
• Assists with control of costs through the judicious use of human and materiel resources.
• Other duties as assigned.

Requirements Include

EDUCATION AND WORK EXPERIENCE

• Graduate of an accredited program for nursing education, BSN preferred.
• Current licensure to practice professional nursing in the state of Ohio.
• Current American Heart Association (AHA) Healthcare Provider BLS certification required.
• Certification in specialty (case management) is preferred.
• Minimum of 2 years of medical/surgical experience and/or critical care experience and/or emergency department experience required, 5 years preferred.

KNOWLEDGE AND SKILLS

• Knowledge of community resources and referral processes.
• Knowledge and application of criteria utilized to determine appropriate patient status (inpatient / observation / outpatient).
• Knowledge of rules/regulations of Medicare, Medicaid and third party insurers.
• Successful completion of mandatory requirements including, but not limited to, departmental competencies.
• Demonstration of effective problem-solving, decision-making, interpersonal and team-work skills.
• Demonstration of positive customer service.
• Knowledge of the nursing scope of practice.
• Demonstrates effective verbal and written communication skills.
• Basic computer skills.
• Current knowledge of the American Nurses Association (ANA) Code of Ethics.