Registered Nurse - Inpatient Care Manager

Atrium Health Enterprise; Charlotte (NC); On-site; USD 70,000 - 100,000; Full time

Job summary

Advocate Health Care in Chicago seeks an experienced nurse leader to coordinate discharge planning, case management, and utilization management across patient care teams. You will work with physicians, social workers, and support staff to ensure timely care transitions.

The role requires a Board of Nursing approved RN education program graduate, an active RN license, and at least 3 years of related nursing experience. Strong communication and critical thinking are essential for success.

Qualifications

• Graduate of a Board of Nursing approved nursing education program (RN).
• Current RN license in the state you work and reside (or eligible).
• Typically requires 3 years of related nursing experience.

Responsibilities

• Conducts comprehensive assessments, plans, and initiates interventions within timelines.
• Collaborates with patient, family, and team to align discharge planning with patient goals.
• Provides case management for health care, finances, housing, or psychosocial issues.
• Initiates referrals to ensure timely progression of care and transitions.
• Communicates effectively with the healthcare team and partners with social work.
• Maintains knowledge of regulatory requirements and utilization management processes.

Skills

Prioritization

Communication

Critical thinking

EHR navigation

MS Office basics

Medicare knowledge

Utilization management

Education

RN education program (Board of Nursing approved)

Job description

Major Responsibilities

• Conducts complete assessments, establishes appropriate plans, and initiates interventions within desired timeframes. Collaborates and negotiates effectively with patient, family, and team while striving to achieve patient and organizational goals with regard to patient’s care needs, choice and satisfaction when discharge planning/transitioning care. Utilizes patient/family strengths in the problem-solving process, involving the patient/family and team in the decision-making process beginning on admission and continuing throughout patient’s hospital stay.
• Provides continuity of care and discharge planning services compliant with regulatory standards by providing coordinated relevant options and services based on assessed needs to ensure patient/family and healthcare team is informed and able to proceed with accountabilities in a timely manner. This includes participating in the communication process to facilitate a smooth transition for patient, family, and staff when patients are transferred.
• Provides case management services related to various levels of health care, finances, housing, family discord, or illness adjustment, based department scope. This may include managing family dynamics and crisis situations in a timely and professional manner, using community resources effectively, and educating patient/family regarding access to and use of services.
• Initiates internal and external referrals to assure timely progression of care and transitions. Documents discharge planning interventions and utilization review activity per department and medical center standards in a timely manner. Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria as required by department standards.
• Communicates effectively with the healthcare team. Works in partnership with Social Work and unlicensed support personnel to effectively establish and implement a safe plan of care. Serves as an active member of the MDR and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities.
• Collaborates with managers, physicians, medical directors, advisory groups, and treatment teams for issues related to physician practices and best practices for the patient’s plan of care. Refers cases to physician advisor as needed to ensure efficient progression of care, accurate status, and compliance with regulatory guidelines.
• Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on length of stay and community resources. Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays. Delivers CMS regulatory notices within CMS established timeframes, as appropriate based on-site guidelines.
• Develops and maintains productive relationships with community-based agencies and networks by representing Advocate Health Care in a positive manner working collaboratively, internally, and externally, to meet patient/family needs. Works in collaboration with Advocate Ambulatory Care Management and Continuing Health to meet common goals and outcomes.
• Serves as an educator and expert resource to medical and hospital staff regarding admission status and acute care criteria, utilization management issues, care coordination and discharge planning needs, and relevant regulatory requirements.
• Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.

Major Responsibilities

• Conducts complete assessments, establishes appropriate plans, and initiates interventions within desired timeframes. Collaborates and negotiates effectively with patient, family, and team while striving to achieve patient and organizational goals with regard to patient’s care needs, choice and satisfaction when discharge planning/transitioning care. Utilizes patient/family strengths in the problem-solving process, involving the patient/family and team in the decision-making process beginning on admission and continuing throughout patient’s hospital stay.
• Provides continuity of care and discharge planning services compliant with regulatory standards by providing coordinated relevant options and services based on assessed needs to ensure patient/family and healthcare team is informed and able to proceed with accountabilities in a timely manner. This includes participating in the communication process to facilitate a smooth transition for patient, family, and staff when patients are transferred.
• Provides case management services related to various levels of health care, finances, housing, family discord, or illness adjustment, based department scope. This may include managing family dynamics and crisis situations in a timely and professional manner, using community resources effectively, and educating patient/family regarding access to and use of services.
• Initiates internal and external referrals to assure timely progression of care and transitions. Documents discharge planning interventions and utilization review activity per department and medical center standards in a timely manner. Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria as required by department standards.
• Communicates effectively with the healthcare team. Works in partnership with Social Work and unlicensed support personnel to effectively establish and implement a safe plan of care. Serves as an active member of the MDR and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities.
• Collaborates with managers, physicians, medical directors, advisory groups, and treatment teams for issues related to physician practices and best practices for the patient’s plan of care. Refers cases to physician advisor as needed to ensure efficient progression of care, accurate status, and compliance with regulatory guidelines.
• Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on length of stay and community resources. Completes UM activities as required based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays. Delivers CMS regulatory notices within CMS established timeframes, as appropriate based on-site guidelines.
• Develops and maintains productive relationships with community-based agencies and networks by representing Advocate Health Care in a positive manner working collaboratively, internally, and externally, to meet patient/family needs. Works in collaboration with Advocate Ambulatory Care Management and Continuing Health to meet common goals and outcomes.
• Serves as an educator and expert resource to medical and hospital staff regarding admission status and acute care criteria, utilization management issues, care coordination and discharge planning needs, and relevant regulatory requirements.
• Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.

Education

Graduate of a Board of Nursing approved nursing education program (RN)

License/Registration/Certification

Preferred Bachelor of Science degree in Nursing (BSN).

Current RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside or if declaring a National License Compact (NLC) state as your primary state of residency, meet the licensure requirements in your home state; or for Non-National License Compact states, (where applicable) current RN license or temporary license as a Registered Nurse

Years Of Experience

Typically requires 3 years of related nursing experience. Clinical experience within the assigned population. Extensive knowledge of disease processes and clinical outcomes. Case Management experience or background preferred. Strong critical thinking and analytical skills preferred. Appropriate Professional certification preferred within 3 years of hire

Knowledge Skills And Abilities

• Ability to prioritize and organize work.
• Effective communication skills.
• Utilization of critical thinking and timely decision making.
• Ability to navigate the Electronic Health Record.
• Basic utilization of MS Office products.
• Knowledge of Medicare A and B guidelines.
• Knowledge of Managed Care program requirements/implications.
• Ability to apply elements of Utilization Management programs.

Physical REQUIREMENTS

• Must be able to sit up to approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
• Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally.
• Manual dexterity required for operation computer and calculator.
• Visual acuity required for facilitating review of written documents/computer screens, medical records, and to record information accurately.
• Clear verbal communications and hearing acuity required for receiving instructions and converse on standard telephone.
• Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.
• Exposed to normal office environment; including usual hazards related to operating electrical equipment.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.