Case Manager NEX

Advocate Health; Winston-Salem (NC); On-site; USD 70,000 - 95,000; Full time

Job summary

Advocate Health in Winston-Salem, NC seeks an experienced RN Case Manager to identify patients who would benefit from care coordination, assess needs, and drive discharge planning in collaboration with the nursing team and multidisciplinary staff. The role requires BSN with RN licensure in North Carolina, 5+ years of relevant clinical experience, and preferred MSN.

You will document actions in the EMR, monitor medical necessity, and partner with physicians and payors to optimize outcomes and

Qualifications

• BSN required; MSN preferred.
• Minimum 5 years of relevant clinical experience.
• RN licensure in North Carolina; case management certification recommended within 2 years.

Responsibilities

• Identify patients who would benefit from Case Management interventions.
• Assess data via interview and evaluation to determine needs.
• Develop and implement Plan of Care with nursing and multidisciplinary team.
• Coordinate discharge planning and monitor effectiveness of Plan of Care.
• Document actions in EMR and communicate with providers and payors.

Skills

Interpersonal skills

Verbal and written communication

Case Management experience

EMR documentation

Education

BSN

MSN preferred

Tools

Electronic Medical Record (EMR)

Job description

EDUCATION/EXPERIENCE: Graduate from an accredited school of nursing. BSN required. MSN preferred. Minimum 5 years of relevant clinical experience. Previous Case Management experience preferred LICENSURE, CERTIFICATION, and/or REGISTRATION: Current licensure to practice as a Registered Nurse in the State of applicable state. Certification in case management highly recommended within 2 years of employment. ESSENTIAL FUNCTIONS: 1. Identifies patients who would benefit from Case Management interventions based on an initial screening assessment of discharge needs. 2. Assesses all relevant data and obtains information by interviewing patient/family and performing objective evaluation of patient needs. 3. Ensures that a Plan of Care is developed and implemented in conjunction with nursing to enhance client outcomes in a cost efficient manner by defining desired patient outcomes (goals) with other members of team. Collaborates with the patient, caregivers, the multidisciplinary team and community service providers to effectively execute the Plan of Care. Facilitates. The Case Manager coordinates the discharge planning process; ensuring discharge planning needs are completed. 4. Evaluates and monitors the effectiveness of the discharge planning by facilitating changes in Plan of Care as needed with all members of the multi-disciplinary team. 5. Documents Case Management actions in the Electronic Medical Record and communicates necessary information to providers and payors. 6. Participates in multi-disciplinary rounds to communicate discharge planning and be the driver of patient progression through the system. Establishes partnerships with physicians to achieve institutional goals and contribute to excellent patient care by the organization. 7. Identifies system issues and suggest interventions to the Supervisor to eliminate duplication in services and documents significant variances. Identifies trends/process barriers and participates in development of plans to ensure a method to move patients effectively through the care continuum. 8. Monitors medical necessity of admissions, continued hospitalization, and surgical procedures using criteria approved by the medical staff and evaluates appropriate level of care for patient and notified the Utilization Review staff of necessary changes 9. Utilizes principles of quality improvement in every aspect of performance by participating in unit and organizational quality improvement activities to develop strategies to reduce or resolve variations in practice. 10. Provides age/developmentally-appropriate patient planning and communication in accordance with Age-Specific Care Guidelines for the specific age groups served. 11. Maintains working knowledge of payer and reimbursement practices impacting the plan of care. Demonstrates the ability to guide the patient and family through an evaluation of their options for post discharge care. SKILLS/QUALIFICATIONS: Good interpersonal, communication (verbal, nonverbal and listening skills) and written communication skills. Case Management experience Computer skills (basic) Works in a continually changing work environment WORK ENVIRONMENT: May be exposed to infectious and contagious diseases May be exposed to radiation hazards Contact with patients under wide variety of circumstances Subject to many interruptions Subject to irregular hours PHYSICAL REQUIREMENTS: 0% 35% 65% to to to 35% 65% 100% N/A Activity X Standing X Walking X Sitting X Bending X Reaching with arms X Finger and hand dexterity X Talking X Hearing X Seeing Lifting, carrying, pushing and or pulling: X 20 lbs. maximum X 50 lbs. maximum X 100 lbs. maximum