RN Care Manager

GBMC HealthCare; Baltimore (MD); On-site; USD 68,000 - 110,000; Full time

Job summary

GBMC HealthCare in Baltimore, MD seeks a Registered Nurse in Case Management to coordinate inpatient care, discharge planning, and utilization review. Requires a BSN or ASN with BSN enrollment and 2+ years in case management, including discharge planning and readmission initiatives.

Strong communication and critical-thinking skills are essential. Role involves collaboration with interdisciplinary teams, payers, and physicians to optimize patient outcomes and reimbursement.

Qualifications

• BSN or ASN with BSN enrollment and expected graduation within 3 years.
• 2+ years of Case Management including Discharge Planning and Re-Admission Initiatives.
• Diversified, progressive acute care experience preferred.
• Knowledge of care management theories, principles, and standards.
• Advanced oral and written communication skills.
• Ability to resolve complex problems and stay calm under pressure.
• Ability to assess discharge needs for patients.

Responsibilities

• Assess patients within a defined caseload to identify clinical status, needs, resources, and goals.
• Review admission and continued stay criteria for defined patients and plan care with payer/clinical guidelines.
• Identify and coordinate discharge needs, referrals, and community resources for implementation.
• Coordinate services with managed care and third-party payers; ensure timely authorizations.
• Educate physician, nursing, and ancillary staff on care management and documentation requirements.
• Lead or participate in health care team meetings to coordinate care and discharge planning.

Skills

Case management

Discharge planning

Re-admission initiatives

Critical thinking

Communication

Interdisciplinary collaboration

Education

BSN or ASN with BSN enrollment

Tools

Electronic Health Records (EHR)

Job description

Under general supervision, manages and coordinates process of care for inpatients to facilitate quality cost-effective patient outcomes. Works collaboratively with interdisciplinary staff internal and external to the organization. Coordinates with payer and physicians to ensure the maximum reimbursement for the hospital through the utilization review process. Responsible for discharge planning and coordination of care with interdisciplinary team. Collaborates with service line team members to distribute patient case load.EducationBachelor of Science in Nursing (BSN) OR Associate of Science in Nursing and currently enrolled in a BSN program with an expected graduation date within three (3) yearsExperienceTwo (2) years of Case Management which includes, Discharge Planning and working with Re-Admission Initiatives.Diversified, progressive experience in acute care and/or other settings within the continuum preferredSkillsKnowledge of care management theories, principles, and standardsSkill in using computer software programsAdvanced skill in oral and written communicationAdvanced skill in critical thinkingAbility to resolve complex problemsAbility to remain calm under pressure and intense time constraintsAbility to assess discharge needs for patientsLicensures, CertificationsCurrent state of Maryland Registered Nurse licenseBachelor of Science in Nursing (BSN) OR documentation of current enrollment in BSN program with expected graduation within three years of hireCare Management highly desired.Physical RequirementsAbility to sit, stand, stoop, and bend.Working ConditionsPrimarily on clinical units, evaluating patient records and interviewing patients and families, working with interdisciplinary staff up to 70% of time. Remainder of time in office environment on the phone or performing electronic documentation.Conditions of EmploymentMaryland RN licensure – current and ongoingReports to DIRECTOR of Care ManagementPatient & Workplace SafetyEmployee has knowledge and understanding of patient and workforce safety as it relates to job duties.Patient PopulationDemonstrates competency in the delivery of care and applies the knowledge to meet age-specific needs if applicable.Principal Duties and Responsibilities:Assesses patients within a defined caseload to identify clinical status, needs, issues, financial resources, and care goals; demonstrates knowledge of reimbursement mechanisms. Considers patient’s financial resources for meeting healthcare needs (insurance reimbursement, managed care plans, entitlement programs, and personal resources).Continually assesses patient care management needs through frequent rounds and communication with physicians and other appropriate members of the health care team. Serves as liaison for the patient, physician, and health care team to implement the processing of the patient centered plan throughout the continuum.Reviews the appropriateness of admission and continued stay criteria for a defined group of patients and either develops a concurrent stay and/or discharge plan of care in accordance with payer and clinical guidelines.Identifies, plans, modifies, and coordinates patient discharge needs, making appropriate referrals, and utilizing available community resources as needed for implementation. Formulates a plan that addresses the continuing needs of the patient following discharge from the acute care setting.Maintains a working knowledge of the requirements and clinical criteria guidelines of payers. Coordinates services with managed care companies and other third party payers. Discusses on-site reviewer issues with payer, either via the telephone or in person. Assures timely utilization compliance with all payers who require authorizations.Provides necessary services for effective post discharge placement in another facility, by obtaining necessary pre-authorization, transportation, and contacting (if necessary) the proposed facility regarding clinical information and services required.Identifies the need for, arranges, and conducts health care team meetings when necessary to facilitate the coordination of care and discharge planning for complex patients and high utilization of resources.Participates in education of physician, ancillary, and nursing staff regarding care management, financial and clinical outcomes, as well as documentation requirements/standards.Identifies service specific procedures and system obstacles that affect patient outcomes. Consults with health team members to address problems, and makes recommendations to resolve them. Collaborates with social work on complex discharge planning needs.Keeps management informed and up to date on clinically complex, emotionally intense, politically sensitive, and financially weighty cases, offering possible solutions through discussion and feedback.All roles must demonstrate GBMC Values:RespectI will treat everyone with courtesy. I will foster a healing environment.Treats others with fairness, kindness, and respect for personal dignity and privacyListens and responds appropriately to others’ needs, feelings, and capabilitiesExcellenceI will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.Meets and/or exceeds customer expectationsActively pursues learning and self-developmentPays attention to detail; follows throughAccountabilityI will be professional in the way I act, look and speak. I will take ownership to solve problems.Sets a positive, professional example for othersTakes ownership of problems and does what is needed to solve themAppropriately plans and utilizes required resources for various job dutiesReports to work regularly and on timeTeamworkI will be engaged and collaborative. I will keep people informed.Works cooperatively and collaboratively with others for the success of the teamAddresses and resolves conflict in a positive waySeeks out the ideas of others to reach the best solutionsAcknowledges and celebrates the contribution of othersEthical BehaviorI will always act with honesty and integrity. I will protect the patient.Demonstrates honesty, integrity and good judgmentRespects the cultural, psychosocial, and spiritual needs of patients/families/coworkersResultsI will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.Embraces change and improvement in the work environmentContinuously seeks to improve the quality of products/servicesDisplays flexibility in dealing with new situations or obstaclesAchieves results on time by focusing on priorities and manages time efficientlyPay Range$68,281.18 - $110,274.20Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.Equal Employment OpportunityGBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.