Registered Nurse Care Manager - Integrated Care Management - (Job Number: 23004176)

McLaren Health Care; Pontiac (MI); On-site; USD 65,000 - 85,000; Full time

Job summary

Join a leading healthcare provider as a Registered Nurse Care Manager responsible for coordinating patient care and ensuring safe transitions. This role involves collaborating with healthcare teams, managing patient needs, and documenting care plans to optimize outcomes within our integrated care management system.

Qualifications

• State licensure as a Registered Nurse (RN) is required.
• Minimum of three years of acute hospital care experience.
• Basic Life Support (BLS) certification is needed.

Responsibilities

• Coordinates patient care transitions and assessments.
• Collaborates with teams to ensure timely patient transitions.
• Documents plans and assessments to facilitate discharges.

Skills

Care Coordination

Patient Advocacy

Interdisciplinary Collaboration

Education

Bachelor's degree in nursing

Job description

Registered Nurse Care Manager - Integrated Care Management - (Job Number: 23004176)

Pay: Competitive

Employment type: Other

Job Description

Accountable for proactive coordination and timely transition of assigned patients to the most appropriate level of care along the continuum. Impacts key results such as achieving top decile performance in length of stay, cost-efficient resource utilization, preventing readmissions, and unnecessary emergency room visits. Works collaboratively with physicians, nursing staff, members of the multidisciplinary team (such as Home Care and PCP offices), as well as other internal and external resources.

Essential Functions and Responsibilities:

1. Performs care coordination assessments within 24 hours of admission, including assessments for readmission and transition planning.
2. Collaborates with social workers and other disciplines to ensure safe, appropriate, and timely patient transitions, considering available resources.
3. Assesses patient and family needs to reduce barriers and develop discharge plans, addressing LOS barriers to discharge.
4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurses and obtains orders from providers.
5. Reviews current DRG/LOS data within Cerner to assess discharge planning needs and identifies the primary family contact.
6. Assesses readmission risk for specific patient populations and initiates interventions to support successful transitions.
7. Coordinates discharge planning and referrals to social services, outpatient case management, DME, post-acute placement, and other agencies per SOP.
8. Acts as a liaison, collaborating daily with physicians, patients, families, nursing, and the healthcare team.
9. Participates in clinical case reviews and rounds with the interdisciplinary team.
10. Documents assessments, plans, interventions, barriers, and reassessments in the EMR to facilitate discharges and transitions, ensuring all pertinent information is transferred to post-acute agencies.
11. Identifies barriers early during patient stay and develops plans with the healthcare team, patient, and family.
12. Reports avoidable days, variances, or service delays to leadership.
13. Represents the care management department on teams, committees, and projects related to performance outcomes.
14. Ensures follow-up appointments with PCP are scheduled prior to discharge.
15. Maintains efficient operations by adhering to policies and procedures.
16. Performs other duties as required.

Required Qualifications:

• State licensure as a Registered Nurse (RN)
• Bachelor’s degree in nursing from an accredited institution or actively pursuing one, to be completed within five years of employment.
• Minimum of three years of acute hospital care experience
• American Case Management Certification (ACM) or eligible for certification, with ongoing continuing education
• Basic Life Support (BLS) certification from AHA, Red Cross, or equivalent

Preferred Qualifications:

• Experience in utilization management, case management, critical care, or patient outcomes/quality management
• Certification in Case Management (ACM or CCM)

McLaren Oakland (POHRMC)
50 N Perry St
Pontiac, MI 48342

About the company

The McLaren Health Care system includes 15 hospitals, 2 HMOs, ambulatory surgery centers, diagnostics, an employed physician network, and more.

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