Nurse Case Manager: Inpatient & ED Discharge

Nemours-Children; Wilmington (DE); On-site; USD 85,000 - 115,000; Full time

Job summary

Nemours is seeking a Nurse Case Manager to coordinate care for patients in inpatient and Emergency Department settings. Using the nursing process, the NCM assesses, plans, implements, and evaluates care with a focus on efficient discharge and appropriate resource use.

The NCM collaborates with an inter-disciplinary team to improve outcomes such as timely discharge, post-discharge connections, reduced readmissions, and family-centered care in line with ACMA and CMSA standards, maintaining DE

Qualifications

• Active RN license in the applicable state(s) is required.
• Case management or utilization management certification is preferred.
• Minimum of five (5) years of progressive clinical experience, including utilization management, case management, or related healthcare operations.

Responsibilities

• Assess inpatient and Emergency Department patients for discharge planning needs, social drivers of health, gaps in care, and post-acute services and supplies.
• Collaborates with providers, social work, and the interdisciplinary team to develop and implement patient-centered plans of care and discharge plans, with a clear timeline and estimated discharge date.
• Monitors clinical progression and barriers to discharge; escalates issues to support appropriate level of care, length of stay, and resource utilization.
• Partners with Utilization Management to support medical necessity and correct patient status (inpatient vs. observation/OPER); supports denial prevention and appeals through timely, complete clinical documentation, educating providers around medical necessity/denials, and support for peer to peer reviews.
• Identifies patients at risk for unsafe transitions, high ED utilization, or readmission; completes transition assessments and coordinates follow-up care and appointments.
• Communicates with patients/families and the care team to address barriers, coordinate services, and adapt plans based on changes in clinical status or goals of care.
• Provides patient/family education on the discharge process, including follow-up needs, and medications/supplies; confirms understanding and documents education as appropriate.
• Initiates and coordinates referrals to internal and community resources to support discharge needs (e.g., home health, DME, transportation, pharmacy). Ensure timely and accurate delivery and fulfillment of discharge resources.
• Coordinates transitions of care with outside hospital/facility case management and care coordination teams, including discharge to home, transfer to another acute care facility, home services, or skilled nursing facility

Skills

Case management

Utilization management

Discharge planning

Education

Diploma/AD

BSN preferred

Job description

Nemours is seeking a Nurse Case Manager to coordinate care for patients in inpatient and Emergency Department settings. Using the nursing process, the NCM assesses, plans, implements, and evaluates care with a focus on efficient discharge and appropriate resource use.

The NCM collaborates with an inter-disciplinary team to improve outcomes such as timely discharge, post-discharge connections, reduced readmissions, and family-centered care in line with ACMA and CMSA standards, maintaining DE