Case Manager

United Hospital Center; Bridgeport (WV); On-site; USD 65,000 - 75,000; Full time

Job summary

United Hospital Center is seeking a skilled RN to plan targeted patient populations and manage resources for transition and discharge planning. You will work with the multidisciplinary care team to ensure timely, safe, and cost-effective transitions and referrals to post-acute services.

The role requires an active RN license and at least three years of clinical experience; BSN is preferred. The position emphasizes education for staff, physicians, patients, and families and ongoing collaboration

Qualifications

• RN license required in state of service or multi-state license via eNLC.
• Three years of clinical experience required.
• BSN preferred.

Responsibilities

• Manages all aspects of transition/discharge planning for assigned patients in a timely manner.
• Collaborates with the multidisciplinary team to facilitate transition/discharge for designated caseload.
• Monitors progress and ensures plan of care is patient-focused, high quality, efficient, and cost-effective.
• Provides education to staff, physicians, patients, and families for effective transition planning.
• Interacts directly with patient/family to assess needs and develop individual transition/discharge plan with physician input.
• Communicates with the team and post-acute providers about complex family dynamics affecting care and planning.
• Initiates referrals to post-acute services (Homecare, DME, Hospice, LTAC, Acute Rehab, SNF).
• Ensures documentation of transition/discharge activities per policy.
• Assists with patient power of attorney, surrogate, and advanced directives.

Skills

Discharge planning

Care coordination

Documentation

Education

RN license

BSN

Job description

This position comprehensively plans for targeted patient populations. Performs resource management, including denial management, utilization management, access to the appropriate level of care, discharge planning, care facilitation, and referral to other levels of care. Works collaboratively with the multidisciplinary care team to facilitate achievement of desired treatment outcomes.

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).

Experience

• Three (3) years clinical experience.

Preferred Qualifications

• Bachelor’s degree in Nursing (BSN)

CORE DUTIES AND RESPONSIBILITIES:

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Manages all aspects of transition/discharge planning for assigned patients in a timely manner.
• Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload.
• Monitors the patient’s progress; intervening as necessary and appropriate, to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
• Provides education as needed to staff, physicians, and patients and their families to ensure effective transition planning.
• Meets directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team.
• Communicates with the multidisciplinary team and post-acute providers when applicable, any complex family dynamics that may directly impact patient care and transition/discharge planning.
• Initiates and facilitates referrals to post-acute services- including but not limited to: Homecare, Durable Medical Equipment, Hospice Care, Long Term Acute Care Facilities, Acute Rehab Facilities, and Skilled Nursing Facilities.
• Communicates all necessary information regarding transition/discharge plan to the multidisciplinary team, patient and family.
• Provides timely and comprehensive documentation of interactions with patient and/or families and all transition/discharge planning activities and progress according to departmental policy.
• Assists patient/families with completion of medical power of attorney, health care surrogate, and advanced directives
• Collaborates for appropriate resource and financial management which may include but is not limited to: financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination
• Utilizes quality screens in the electronic record to identify potential issues including but not limited to- avoidable delays and readmissions.
• Completes clinical reviews for patients.
• Applies approved utilization criteria to ensure medical necessity of patient’s admissions and continued stays, and documents the findings based on department standards, policy and procedure.
• Screens for appropriate authorization and level of care.
• Facilitates covered day reimbursement certification for assigned patients and discusses payor criteria and issues on a case by case basis with clinical staff (ie. Peer to Peer) and follows up to resolve problems with payors as needed.
• Educates hospital staff and physicians to payer regulations and managed care principals to prevent denials.
• Fosters the integration of staff and/or students into the healthcare team.

For Facilities With Specialty Accreditation Requirements

• Completion of annual required education related to specialty accreditation as defined by accreditation standards. Training may be completed through CBLs, trainings, In-services, and competency validation.

PHYSICAL REQUIREMENTS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling are necessary body movements utilized in performing nursing duties throughout the work shift.
• Must be able to lift, move, and position patients of all weights, with varying amounts of assistance in a fair manner on a regular and recurring basis.
• Hearing within a normal range required (e.g., to assess breath sounds, heart sounds, apical pulse, monitors, etc.).
• Visual acuity must be within normal range. Must be able to perform night driving as necessary for patient care.
• Must be able to perform heavy work; exerting in excess of 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.

WORKING ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Working closely with others.
• Working protracted or irregular hours.
• Working around biohazards.
• Working around infectious diseases.
• Working with hands in water.
• Working with electrical hazards associated with patient care equipment.

Skills And Abilities

• Knowledge of patient’s current medical insurance coverage and limitations and the precertification requirements for Durable Medical Equipment (DME), post-acute placements, infusions, transfers etc
• Knowledge of relevant scientific principles, established standards of care and/or research findings.
• Knowledge of procedures and techniques involved in administering routine and special treatments to patients.
• Knowledge of and appropriate application of the nursing process.

Additional Job Description

Scheduled Weekly Hours:

36

Shift

Day (United States of America)

Exempt/Non-Exempt

United States of America (Exempt)

Company

UHC United Hospital Center

Cost Center

405 UHC Quality Management

Address

327 Medical Park Drive

Bridgeport

West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.