Complex Inpatient Case Manager

112 North Carolina Baptist Hospital; Winston-Salem (NC); On-site; USD 117,768,000 - 176,818,000; Full time

Job summary

Wake Forest Baptist Medical Center in Winston-Salem, NC seeks an experienced Nurse Care Manager to oversee complex patient care planning and discharge coordination. You will collaborate with the clinical team to ensure seamless transitions, optimize outcomes, and advocate for patients and families.

The role requires RN licensure, a BSN, and 2+ years in clinical nursing plus 3 years in care management, with strong communication and data analysis skills.

Qualifications

• Registered Nurse license in the state of practice.
• 2 years clinical nursing experience and 3 years care management experience.
• Bachelor’s degree in nursing.

Responsibilities

• Perform thorough patient assessments and develop care plans.
• Coordinate discharge planning and care transitions.
• Analyze and report patient outcomes and resource use.
• Lead multidisciplinary rounds and mentor care management staff.
• Maintain knowledge of regulatory guidelines and CMS notices.

Skills

Prioritization & organization

Communication

Critical thinking

Electronic health record

MS Office

Medicare guidelines

Managed care

Utilization management

Education

Bachelor's degree in nursing

Job description

Department

Department: 34033 Wake Forest Baptist Medical Center - Nursing: Care Coordination Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: M-F Pay Range: $41.10 - $61.65

Major Responsibilities

• Perform thorough patient assessments, identifying critical health issues and implement targeted interventions and patient-family centered care plans to achieve optimal health outcomes.
• Collaborate and negotiate effectively with clinically complex patients, family and the clinical team while striving to achieve patient and organizational goals regarding care needs, choices, and satisfaction during discharge planning and care transitions.
• Aggregate, analyze, interpret and report data on patient outcomes and resource utilization.
• Facilitate reporting of utilization monitoring and review activities to relevant committees and stakeholders
• Provide continuity of care and discharge planning services for clinically complex patients compliant with regulatory standards.
• Offers coordinated, relevant options and services based on assessed needs to ensure patient, families, and the healthcare team are informed and prepared to proceed with accountabilities in a timely manner.
• Participate in the communication processes to facilitate smooth transitions for patients, families, and staff during patient transfers.
• Provide advanced clinical guidance and mentorship to frontline care management team members fostering a culture of excellence and continuous improvement.
• Lead initiatives aimed at enhancing care quality, patient safety, and overall healthcare delivery efficiency.
• Advocate for patients and their families to ensure their voices are heard and their needs are met within the healthcare system while optimizing the utilization of hospital resources ensuring cost-effective care delivery and adherence to regulatory guidelines.
• Initiate internal and external referrals to assure timely progression of care and transitions for clinically complex patients.
• Document discharge planning interventions and utilization review activity according to department and organization standards in a timely manner.
• Perform and document accurate and timely concurrent and retrospective reviews for clinically complex patients based on approved criteria by department standards.
• Communicate effectively with the healthcare team regarding clinically complex patients.
• Partner with Social Work and unlicensed support personnel to effectively establish and implement a safe plan of care.
• Serves as a leader of the multidisciplinary rounds and work closely with clinical team members, hospital departments and ancillary services to identify and resolve barriers to discharge, expedite care delivery to avoid delays in timely service provision, and implement and report on care coordination and discharge planning.
• As an expert in care management of clinically complex patients, collaborate and lead discussions with managers, physicians, medical directors, advisory groups, and treatment teams for issues related to physician practices and best practices for the patient care plans.
• Refer cases to physician advisors as needed to ensure efficient progression of care, accurate status, and compliance with regulatory guidelines.
• Maintain knowledge of healthcare regulations, reimbursement issues, impact on length of stay and community-based resources.
• Deliver CMS regulatory notices within CMS established timeframes, as appropriate based on-site guidelines.
• Develop and maintain productive relationships with community-based agencies, particularly those serving clinically complex patients.
• Represent Advocate Health in a positive manner, working collaboratively, internally and externally to meet patient and family needs.
• Collaborate with Advocate Health Ambulatory Care Management and Continuing Health to achieve mutual goals and outcomes.
• Demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served.
• Understand principles of growth and development over the lifespan and possess the ability to assess data reflective of the patient status and interpret the appropriate information needed to identify each patient’s age-specific needs, and provide the care needed as described in departmental policies and procedures.
• Age-specific information is further developed in the departmental job standards.

Licensure, Registration, and/or Certification Required

Registered Nurse License issued by the State in which the team member practices. Accredited Care Manager (ACM) certification issued by the American Case Management Association (ACMA) needs to be obtained within 2 years, or Care Manager Certified (CMC) certification issued by the National Academy of Certified Care Managers (NACCM) needs to be obtained within 2 years, or Nurse Case Management (RN-BC) certification issued by the American Nurses Credentialing Center (ANCC) needs to be obtained within two (2) years.

Education Required

Bachelor’s degree in nursing

Experience Required

2 years of clinical nursing experience and 3 years of care management experience

Knowledge, Skills & Abilities Required

• Ability to prioritize and organize work.
• Effective communication skills.
• Utilization of critical thinking and timely decision making.
• Ability to navigate the electronic health record.
• Basic utilization of MS Office products.
• Knowledge of Medicare A and B guidelines.
• Knowledge of managed care program requirements/implications.
• Ability to apply elements of utilization management programs.

Physical Requirements and Working Conditions

Must be able to sit up to approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time. Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally. Manual dexterity required for operation computer and calculator. Visual acuity required for facilitating review of written documents/computer screens, medical records, and to record information accurately. Clear verbal communications and hearing acuity required for receiving instructions and converse on standard telephone. Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone. Exposed to normal office environment; including usual hazards related to operating electrical equipment. Operates all equipment necessary to perform the job.

Preferred Job Requirements

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.).

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits. This is Transformation One shared purpose brought us together. Now, as one of the 10 largest not-for-profit, integrated health systems in the United States, our combined strength and stability drives us forward. Starting with You Caring for nearly 3 million people has inspired a transformation. One in which the patient’s experience guides our vision and empowers us to offer new possibilities in our communities. Reshaping Access What is access? It’s offering more sites of care than any other health system in the Midwest. But there’s a new frontier. Access is exploring the latest technologies to deliver care to patients exactly where they are and exactly when they need it Inspiring Professionals With our dynamically inclusive workforce and strong connections to the places where we live and work, we’ll touch more lives and contribute to stronger and more vibrant communities. Transforming Care We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in: Cardiovascular Care Neurosciences Gynecology Oncology Pediatrics Primary Care Neurology Geriatrics Trauma Care