Case Manager (RN)

Luminis Health; Lanham (WV); On-site; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager (RN) to enhance patient care coordination. This role involves working collaboratively to assess and implement care plans, ensuring timely transitions for patients across various settings. The ideal candidate will leverage their clinical expertise to engage patients, promote self-care, and utilize evidence-based guidelines to optimize health outcomes. Join a forward-thinking organization that values your contributions and offers a comprehensive benefits package, including medical, dental, and vision insurance, retirement plans, and wellness programs. Make a meaningful impact in the healthcare community with this exciting opportunity.

Benefits

Medical, Dental, and Vision Insurance

Retirement Plan with employer match

Paid Time Off

Tuition Assistance Benefits

Employee Referral Bonus Program

Paid Holidays

Disability and Life/AD&D Insurance

Wellness Programs

Eligible for shift differentials/OT

Employee Assistance Programs

Qualifications

• BSN or ADN required with 3 years of clinical experience.
• Experience in care coordination preferred.

Responsibilities

• Coordinate care transitions and manage patient needs effectively.
• Utilize evidence-based guidelines to ensure quality care.

Skills

Care Coordination

Motivational Interviewing

Clinical Documentation

Patient Engagement

Evidence-Based Guidelines

Education

BSN or ADN

3 years clinical experience

Tools

Epic

InterQual

Job description

Case Manager (RN)

Doctors Community Medical Center, Lanham, MD

Full Time - Day shift (M-F, 8am-4:30pm, rotating weekends & holidays)

Position Objective:

The Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Anne Arundel Medical Center to support safe, seamless, timely transitions across the continuum. Utilizing a collaborative process, will identify (using quantitative and qualitative methods), assess, plan, implement and evaluate the options and services required to meet an individual’s health and health related needs, including social determinants that affect one's overall wellbeing. Promotes the right resources, at the right time and at the right level of care and is responsible for engaging and supporting patients that are in need of care management services; is able to determine, using evidence-based guidelines, the correct initial and ongoing level of care for patients and is able to submit appropriate denial review for Medicare, Medicaid and commercial insurers.

Essential Job Duties:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Identifies and prioritizes patients in need of care management services, using a holistic approach inclusive of biopsychosocial, functional, cultural, spiritual, and financial factors; uses a multidisciplinary approach to assess/plan for care needs.
2. Identifies and implements strategies such as motivational interviewing to promote patient engagement, self-care, treatment adherence, and optimal levels of health and well-being.
3. Utilizes evidence-based guidelines (such as InterQual or other agreed upon evidence-based guidelines) to promote quality care, decrease variation and mitigate waste. Verifies appropriate level of care; enters clinical review and authorized days in Epic; documents actions to avoid denied days; refers cases to Physician Advisor as appropriate.
4. Manages observation stay patients assertively and ensures timely testing, treatment and conversion to inpatient status or discharge.
5. Develops and coordinates transition plans for patients transitioned to home with home health, community care coordination program, Hospice or Palliative care, home infusion and routine sub-acute and skilled post-acute providers; completes all necessary documentation and necessary handovers. Involves and prepares patients and families for transition from the ED, Peds, Clatanoff for Observation unit as indicated.
6. Maintains clear and concise documentation in each patient record to reflect physical and functional limitations, psychosocial characteristics, educational needs of patient & family, family/social support systems, financial, economic, and transition needs. Initiates referrals to disciplines as indicated.
7. Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.
8. Identifies potential or current patient situations which require referral to other members of the health care team such as infection control, risk management, or quality management. Assures plan of care is adjusted as appropriate and that follow-up occurs. Keeps leadership abreast of potential issues.
9. Utilizes all risk and predictive analytic tools such as the readmission risk tool. Applies tailored interventions to mitigate potential barriers or risk, prolonged unnecessary hospitalization and readmission prevention.
10. Maintains compliance with all regulatory standards (CMS, commercial insurers etc).

Educational/Experience Requirements:

BSN or ADN with equivalent experience. BSN must be achieved within 5 years of start date in the role.

Three years of experience in a clinical setting, ambulatory or post-acute.

Care coordination experience preferred.

Licensure/Certification:

Current licensure as a registered nurse by the Maryland Board of Nursing.

Adherence to the credentialing requirements of AAMC as stated in the nursing bylaws.

Working Conditions, Equipment, Physical Demands:

There is reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands - Medium work.

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.

Luminis Health Benefits Overview:

• Medical, Dental, and Vision Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Eligible for shift differentials/OT
• Employee Assistance Programs and more

*Benefit offerings based on employment status