Registered Nurse Care Manager PRN Days

Baptist-Health; Homewood (AL); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Medical, Dental, Vision

403(b) Retirement Savings Plan

Health Savings Account

Flexible Spending Account

Paid Time Off

Life Insurance

Extended Leave Plan

Family Care

Tuition reimbursement

Job summary

Baptist Health Brookwood Hospital is seeking an experienced RN for care management to coordinate patient care from admission to discharge. You will work with the clinical team to identify patients who benefit from care coordination, assess risk factors, and manage transitions to the next level of care.

The role emphasizes utilization management, clinical collaboration, and ensuring compliance with regulatory standards.

Qualifications

• Graduate of an approved school of nursing.
• Current Alabama RN license.
• Handle with Care (HWC) certification within 90 days of hire.
• Three years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.

Responsibilities

• Accurate medical necessity screening and submission for Physician Advisor review.
• Care coordination including admitting diagnosis, medical history, current treatments, age, payment source, resources, and expected length of stay.
• Identification and referral of complex patients to Social Work Services.
• Communicating with patients and families about the plan of care.
• Educates physicians, patients, families, and caregivers about care plans and discharge.
• Maintains compliance with regulatory standards and Utilization Management Plan.

Skills

Organizational skills

Verbal & written communication

Leadership & coordination

Critical thinking

Education

Nursing degree

Tools

Computer literacy

Job description

Position Summary

At Baptist Health, our mission is to improve the health and quality of life for the individuals and communities we serve.

Baptist Health Brookwood Hospital offers great NEW competitive pay and benefits!

• Medical, Dental, Vision
• 403(b) Retirement Savings Plan w/matching
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Paid Time Off (up to 5 weeks to start)
• Life Insurance
• Extended Leave Plan (ELP)
• Family Care (childcare, elder care, pet care)
• Educational Benefits including tuition reimbursement & monthly payments to help pay down any graduated school debt

ALL benefits start on day one!

Position Summary

Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patients most likely to benefit from care coordination services to include assessing patients' risk factors and the need for care coordination, clinical utilization management and the transition to the next appropriate level of care.

Responsibilities

Essential Functions

• Accurate medical necessity screening and submission for Physician Advisor review
• Care coordination that includes admitting diagnosis/ medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other relevant information.
• Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and transition planning as appropriate through assessment and reassessment and the application of InterQual guidelines.
• Leading and facilitating multi-disciplinary patient care conferences
• Managing concurrent disputes
• Making appropriate referrals to other departments
• Identifying and referring complex patients to Social Work Services
• Communicating with patients and families about the plan of care
• Leading and facilitating Complex Case Review
• Identification and documentation of potentially avoidable days
• Identification and reporting over and underutilization
• Ensures compliance with all regulatory standards including Federal, State, Local and Joint Commission with review requirements for Managed Contracts, Medicare, Medicaid, and Campus related to admission and continued stay approval.
• Adheres to Utilization Management Plan.
• Integrates National standards for care management scope of services including:
• Utilization Management supporting medical necessity and denial prevention
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level of care
• Education provided to physicians, patients, families, and caregivers.
• Communicates appropriately and timely with the interdisciplinary team and third-party payers.
• Prioritizes activities in assigned areas to focus on high risk, high cost, and problem prone areas.
• Develops collaborative relationships with patient business, nursing, physicians, and patient/family to facilitate efficient movement through the continuum of care.
• Monitors and evaluates data, fiscal outcomes, and other relevant information to develop and implement strategies for improvement.
• Forwards identified quality and/or risk issues appropriately.
• Maintains positive relationships with outside/onsite reviewers and other payer representatives.
• Identifies cultural, socio-economic, religious, and other factors that may impact treatment.
• Involves patient’s family in the development of the treatment plan as appropriate while explaining procedures, therapies, systems treatment plans, and discharge plans in age/developmental/educational specific terms to patient/family.
• Reviews patient’s discharge plan at multidisciplinary meetings and/or staffing to facilitate communication with other healthcare team members.
• Prioritizes workload to manage multiple priorities while using problem‑solving skills to meet goals.
• Enhances professional growth by participating in educational programs, current literature and/or workshops.
• Possesses excellent interpersonal skills and ability to work in a team environment.
• Respects the rights and privacy of others and holds staff member information in strict confidence.
• Maintains reasonably regular, punctual attendance consistent with Baptist Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Baptist Health policies and procedures.

Other Related Functions

• Maintains records and documentation of work performed in an organized and easily retrievable fashion while maintaining confidentiality of data and patient information.
• Reviews current literature on a regular basis, maintains reference materials and updates as required, and keeps abreast of relevant reimbursement information.
• Actively serves on committees and task forces to promote quality, cost‑effective care for patient population.
• Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast‑paced environment, critical thinking and problem‑solving skills and computer literacy.
• Performs other duties as assigned or required.

Qualifications

Education/Training

• Graduate of an approved school of nursing.

Licensure/Certification

• Must hold and maintain a current Alabama RN license.
• Handle with Care (HWC) Certification is required for the Behavioral Health Unit within 90 days of hire. The Handle with Care training and education will be provided onsite to all team members.

Experience

• Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.