Case Management RN (part-time)

NemoursCareerSite; Delaware; On-site; USD 90,000 - 120,000; Full time

Job summary

Nemours is seeking a Nurse Case Manager to coordinate inpatient and Emergency Department care. The NCM will assess, plan, implement and evaluate patient care, focusing on timely discharge, post-discharge connections, and reducing readmissions.

Collaboration with the interdisciplinary team and families will drive outcomes and patient satisfaction. The ideal candidate holds an Associate degree in nursing with an active RN license, and has 5+ years in case management or utilization management, with

Qualifications

• Active RN license in the applicable state(s).
• Associate degree in nursing is required; BSN preferred.
• Minimum of five years of progressive clinical experience including utilization/case management.

Responsibilities

• Assess inpatient and ED patients for discharge planning needs and post-acute services.
• Collaborate with providers and interdisciplinary team to develop patient-centered care and discharge plans with timelines.
• Monitor progression and barriers to discharge; escalate as needed for appropriate resource use.
• Support medical necessity discussions and correct patient status with Utilization Management; assist with denials prevention.
• Identify patients at risk for unsafe transitions; coordinate follow-up care and appointments.
• Communicate with patients and families to address barriers and adapt plans as clinical status changes.
• Educate patients and families on discharge needs, medications, and supplies; document education.
• Coordinate referrals to internal and community resources for discharge needs (home health, DME, transportation).
• Coordinate transitions of care with outside teams, including discharge to home or SNF.

Skills

Active RN license

Case management experience

Strong discharge planning

Education

Associate degree in nursing

BSN preferred

Tools

Certification in case management

Job description

Join our team as a Nurse Case Manager!The Nurse Case Manager (NCM) is responsible for the coordination of care of individual patients in the Inpatient and Emergency Department acute care environment. Through the use of the nursing process, patient care will be assessed, planned, implemented and evaluated with consideration to the appropriate use of resources, anticipatory discharge and timely progression of care. The NCM will manage care with a focus on designated clinical, operational, and financial outcomes for aggregate patient populations. In collaboration with the interdisciplinary team and a family-centered process, the NCM will work to improve outcomes as measured by timely discharge from acute inpatient care, connection to post-discharge care/appointments, family/caregiver access to needed supplies, reduced readmission rates, and improved patient/family satisfaction.

Primary Responsibilities:

1. Assesses inpatient and Emergency Department patients for discharge planning needs, social drivers of health, gaps in care, and access to post-acute services and supplies (e.g., DME, home nursing).
2. Collaborates with providers, social work, and the interdisciplinary team to develop and implement patient-centered plans of care and discharge plans, with a clear timeline and estimated discharge date.
3. Monitors clinical progression and barriers to discharge; escalates issues to support appropriate level of care, length of stay, and resource utilization.
4. Partners with Utilization Management to support medical necessity and correct patient status (inpatient vs. observation/OPER); supports denial prevention and appeals through timely, complete clinical documentation, educating providers around medical necessity/denials, and support for peer to peer reviews.
5. Identifies patients at risk for unsafe transitions, high ED utilization, or readmission; completes transition assessments and coordinates follow-up care and appointments.
6. Communicates with patients/families and the care team to address barriers, coordinate services, and adapt plans based on changes in clinical status or goals of care.
7. Provides patient/family education on the discharge process, including follow-up needs, and medications/supplies; confirms understanding and documents education as appropriate.
8. Initiates and coordinates referrals to internal and community resources to support discharge needs (e.g., home health, DME, transportation, pharmacy). Ensure timely and accurate delivery and fulfillment of discharge resources.
9. Coordinates transitions of care with outside hospital/facility case management and care coordination teams, including discharge to home, transfer to another acute care facility, home services, or skilled nursing facility

Qualifications:

• Associate degree in nursing required; BSN preferred
• Active Registered Nurse license in the applicable state(s) (required)
• Case management or utilization management certification (preferred)
• Minimum of five (5) years of progressive clinical experience, including utilization management, case management, or related healthcare operations required