Case Manager RN

CareWell Health; East Orange (NJ); On-site; USD 65,000 - 110,000; Full time

Job summary

CareWell Health seeks an experienced registered nurse for comprehensive case management of hospitalized patients to improve quality of life and safe community functioning. The role emphasizes discharge planning, care coordination, and collaboration with care teams.

Responsibilities include assessing needs, reviewing admissions, coordinating home health and equipment, and liaising with payers and community agencies to ensure timely, appropriate patient care on discharge.

Qualifications

• RN with discharge planning and case management experience preferred.
• Experience with utilization review and coordination of post-discharge care.
• Familiarity with Medicare/Medicaid policies and home health services.

Responsibilities

• Implements discharge planning for patient populations according to policy.
• Assesses patients and identifies medical, rehabilitation and community support needs.
• Reviews admission status and continued stay for appropriateness.
• Keeps up-to-date knowledge of third-party coverage and post-discharge resources.
• Initiates referrals to departments and agencies to arrange equipment and services at discharge.
• Monitors progress and communicates patient needs to health professionals.
• Leads discharge planning rounds and collaborates with physicians and departments.
• Follows up on utilization of level of care inquiries from payers.

Skills

Discharge planning

Case management

Medicare/Medicaid knowledge

Patient education

Education

RN license

BSN

Job description

Job Summary

Provides comprehensive Case Management to all hospitalized patients to improve quality of life, maintain the highest possible ability to function safely within the community.

Essential Functions

• Implements the process of discharge planning for a unit’s patient population according to departmental policy and procedures.


• Assesses all patients and evaluates their medical, rehabilitation and physical needs and identifies support capabilities and needs of family and significant others


• Performs on site admission, concurrent and retrospective chart review in a timely manner to determine appropriateness of patient’s admission and continued stay.


• Maintains and updates working knowledge of Medicare, Medicaid and other third party coverage and current resource list of home medical equipment, supplies and continuing care services and facilities


• Initiates referrals to appropriate departments and services within and outside the hospital in a timely manner and serves as liaison between the hospital and other facilities, home health and community agencies, and makes arrangements as needed for equipment, supplies, and other required items to be available at the time of discharge


• Monitors patient progress and documents observations as required by policy and, on behalf of the patient, communicates the needs (i.e., education) to the appropriate departments and health professionals within and outside the organization


• Leads discharge planning rounds as required by policy and advises physicians and/or hospital departments regarding management concerns with patients’ hospitalization and assists in coordinating efforts to achieve timely and appropriate patient care


• Follows-up with utilization of level of care inquiries from third party payers and/or review agencies


• Establishes professional and unit specific goals on annual basis and works to accomplish these goals and the goals of the Continuing Care Department.


• Maintains knowledge of professional nursing theory and practices


• Organizational policies, regulations and procedures in relation to utilization review, home care, discharge planning


• Servicing equipment and appropriate resources within and outside the hospital


• Maintains skill in relationship with patients, their families, medical staff and outside agencies


• Keeps statistics and records as required


• Assumes additional responsibilities as delegated by the Director of Continuing Care

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Minimum Education/Certifications

Graduate RN, preferably and BSN required

Minimum Work Experience

Medical/Surgical, Critical Care and/or Community Health Nursing experience required

Physical Demands Analysis

The following tables detail the individual physical demands using the following six categories: Mobility, Strength, Upper Extremity Postural Activity, Sensory/Perceptual, Work Environment, and Conditions of Work