PRN/Casual Case Manager (RN or Social Worker)

PCH Princeton Community Hospital; United States; On-site; USD 70,000 - 95,000; Full time

Job summary

WVU Medicine in Princeton, WV is seeking a dedicated RN to lead transition and discharge planning for a designated patient caseload. You will coordinate with a multidisciplinary team to ensure timely, high-quality care and effective post-acute planning, while educating patients and families about the care pathway.

The role requires an active RN license and 5+ years of clinical nursing experience, with BSN preferred.

Qualifications

• Must hold active RN license in the state where services will be provided, or current multi-state RN license via eNLC.
• Minimum five (5) years of clinical nursing experience.
• BSN degree preferred.

Responsibilities

• Manages transition and discharge planning for assigned patients in a timely manner.
• Collaborates with the multidisciplinary team to facilitate the discharge process for designated caseload.
• Monitors patient progress and ensures the plan of care is patient-centered, high quality, efficient and cost effective.
• Provides education to staff, physicians, patients and families to ensure effective transition planning.
• Develops individualized transition/discharge plans in collaboration with the physician team.
• Communicates plan to the multidisciplinary team and to patient/family; facilitates referrals to post-acute services (homecare, DME, hospice, SNFs, etc.).
• Documents interactions and progress according to departmental policy.

Skills

5+ years clinical experience

Education

BSN

Job description

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.

MINIMUM QUALIFICATIONS

• Education, certification, and/or licensure: 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: Five (5) years clinical experience.

PREFERRED QUALIFICATIONS

• Education, certification, and/or licensure: Bachelor’s degree in Nursing (BSN).

CORE DUTIES AND RESPONSIBILITIES

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Manages all aspects of transition/discharge planning for assigned patients in a timely manner.
• Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload.
• 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.
• Provides education as needed to staff, physicians, and patients and their families to ensure effective transition planning.
• Meets directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team.
• 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.
• 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.
• Communicates all necessary information regarding transition/discharge plan to the multidisciplinary team, patient and family.
• Provides timely and comprehensive documentation of interactions with patient and/or families and all transition/discharge planning activities and progress according to departmental policy.
• Assists patient/families with completion of medical power of attorney, health care surrogate, and advanced directives.
• 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.
• Utilizes quality screens in the electronic record to identify potential issues including but not limited to- avoidable delays and readmissions.
• Completes clinical reviews for patients.
• 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.
• Screens for appropriate authorization and level of care.
• 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.
• Educates hospital staff and physicians to payer regulations and managed care principals to prevent denials.
• Fosters the integration of staff and/or students into the healthcare team.
• For facilities with specialty accreditation requirements: Completion of annual required education related to specialty accreditation as defined by accreditation standards. Training may be completed through CBLs, trainings, In-services, and competency validation.

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT

• Working closely with others.
• Working protracted or irregular hours.
• Working around biohazards.
• Working around infectious diseases.
• Working with hands in water.
• Working with electrical hazards associated with patient care equipment.

SKILLS AND ABILITIES

• 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.
• Knowledge of relevant scientific principles, established standards of care and/or research findings.
• Knowledge of procedures and techniques involved in administering routine and special treatments to patients.
• Knowledge of and appropriate application of the nursing process.
• Knowledge of professional theory, practice and procedure.
• Ability to communicate clearly with patients, families, physicians, and other employees.

Additional Job Description

Scheduled Weekly Hours: 8 Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) Company: PCH Princeton Community Hospital Cost Center: 403 PCH Care Management Address: 122 12th Street Princeton West Virginia.

Equal Opportunity Employer 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.