Lead Case Manager Nurse

GRMC Garrett Regional Medical Center; EE. UU.; Presencial; USD 74.000 - 111.000; Jornada completa

Descripción de la vacante

GRMC Garrett Regional Medical Center in Oakland, MD seeks a nurse leader to serve as a lead team member, mentoring staff and coordinating discharge planning for targeted patient populations.

The role requires an RN license (state or multi-state eNLC) and seven years of clinical experience, with BSN preferred. You will oversee staff, ensure timely transitions, and collaborate across disciplines to achieve high-quality, cost-effective care.

Formación

• Current RN license in the state where services will be provided, or an enhanced Nurse Licensure Compact (eNLC) multi-state license.
• Seven (7) years of clinical experience.

Responsabilidades

• Provides leadership and mentoring to the staff.
• Coordinates work flow, assignments, and schedules.
• Manages transition/discharge planning for assigned patients in a timely manner.
• Collaborates with the multidisciplinary team to facilitate transition/discharge for designated caseload.
• Monitors patient progress and ensures plan of care is patient-focused, high quality, efficient and cost effective.
• Educates staff, physicians, patients, and families for effective transition planning.
• Meets with patient/family to assess needs and develop individualized discharge plans with the physician team.
• Communicates plans to multidisciplinary team and post-acute providers as applicable.

Educación

Bachelor’s degree in Nursing (BSN)

Descripción del empleo

Functions as a lead team member and fosters a positive and mentoring work environment. 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. Provides oversight of staff.

Minimum Qualifications

• Education, Certification, and/or Licensure: 1. 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: 1. Seven (7) years clinical experience.

PREFERRED QUALIFICATIONS

• Education, Certification, and/or Licensure: 1. Bachelor’s degree in Nursing (BSN).

Core Duties and Responsibilities

• 1. Provides support, expertise, and leadership to the staff
• 2. Helps with coordinating work flow, work assignments, and schedules
• 3. Manages all aspects of transition/discharge planning for assigned patients in a timely manner.
• 4. Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload.
• 5. 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.
• 6. Provides education as needed to staff, physicians, and patients and their families to ensure effective transition planning.
• 7. Meets directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team.
• 8. 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.
• 9. 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.
• 10. Communicates all necessary information regarding transition/discharge plan to the multidisciplinary team, patient and family.
• 11. Provides timely and comprehensive documentation of interactions with patient and/or families and all transition/discharge planning activities and progress according to departmental policy.
• 12. Assists patient/families with completion of medical power of attorney, health care surrogate, and advanced directives
• 13. 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
• 14. Utilizes quality screens in the electronic record to identify potential issues including but not limited to- avoidable delays and readmissions.
• 15. Completes clinical reviews for patients.
• 16. 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.
• 17. Screens for appropriate authorization and level of care.
• 18. 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.
• 19. Educates hospital staff and physicians to payer regulations and managed care principals to prevent denials.
• 20. Fosters the integration of staff and/or students into the healthcare team.

Physical Requirements

• 1. 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.
• 2. 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.
• 3. Hearing within a normal range required (e.g., to assess breath sounds, heart sounds, apical pulse, monitors, etc.).
• 4. Visual acuity must be within normal range. Must be able to perform night driving as necessary for patient care.
• 5. 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

• 1. Working closely with others.
• 2. Working protracted or irregular hours.
• 3. Working around biohazards.
• 4. Working around infectious diseases.
• 5. Working with hands in water.
• 6. Working with electrical hazards associated with patient care equipment.

Skills and Abilities

• 1. 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
• 2. Knowledge of relevant scientific principles, established standards of care and/or research findings.
• 3. Knowledge of procedures and techniques involved in administering routine and special treatments to patients.
• 4. Knowledge of and appropriate application of the nursing process.

Additional Job Description

Scheduled Weekly Hours: 40

Shift: Exempt/Non-Exempt: United States of America (Exempt)

Compensation Range: $73,715.20 - $110,572.80 (based on 100% FTE). Salary will be prorated if hired at less than 100% FTE.

Company: GRMC Garrett Regional Medical Center Cost Center: 403 GRMC Care Management Address: 251 N 4th Street Oakland Maryland

Benefit eligible employees classified as at least 0.5 eligible for: Medical, Dental, Vision, Disability Coverage, Tuition Program, Retirement, Paid Time Off, Wellness Program

Equal Opportunity Employment

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.

The West Virginia University Health System is a West Virginia-based academic health system that provides the full continuum of healthcare services at 30 hospitals in West Virginia, Pennsylvania, Ohio, and Maryland. With more than 47,000 employees, of which 7,200 are providers, and $10 billion in total operating revenues, the WVU Health System is anchored by an 890-bed academic medical center and the 150-bed WVU Medicine Golisano Children’s Hospital in Morgantown, West Virginia. Together, the Health System’s hospitals, clinics, and specialty programs provide a comprehensive continuum of care, ranging from community-based primary and specialty services to highly complex, quaternary care and post-acute care.