Case Manager Nurse

WVU Medicine; Morgantown (WV); On-site; USD 70,000 - 95,000; Full time

Job summary

WVU Hospitals is seeking an experienced nurse to lead comprehensive transition and discharge planning for assigned patients in Morgantown, WV. You will work with a multidisciplinary team to ensure timely, patient-centered care and smooth transitions to post-acute services.

The role requires an active RN license (state or eNLC) and at least three years of clinical experience; BSN is preferred. You will educate staff and families, coordinate referrals, and document progress according to policy.

Qualifications

• RN license current in the state where services are provided or multistate RN license via eNLC.
• Three (3) years of clinical experience.
• BSN preferred.

Responsibilities

• Plans transition/discharge for assigned patients.
• Collaborates with multidisciplinary team to facilitate discharge.
• Monitors progress and ensures care plan is patient-focused and cost-effective.
• Educates staff, physicians and patients/families on transition planning.
• Develops individualized discharge plans with physician team.
• Coordinates post-acute referrals (home health, DME, hospice, SNF, etc).
• Documents interactions and progress per policy.
• Assists with power of attorney and advance directives as needed.
• Manages resource and financial aspects including entitlements and referrals.

Skills

RN care coordination

Discharge planning

Transition management

Multidisciplinary collaboration

Education for staff/patients

Utilization management

Payer/denials awareness

Post-acute referrals

Education

RN license (state or eNLC)

BSN preferred

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.

Minimum Qualifications

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

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• 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:

• 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:

• 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.

Scheduled Weekly Hours:

40

Shift:

United States of America (Exempt)

Company

WVUH West Virginia University Hospitals

Cost Center

403 WVUH Care Management

Address

1 Medical Center Drive
Morgantown
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.