RN Care Manager

AdventHealth

Burleson (TX)

On-site

USD 47,000 - 87,000

Full time

8 days ago

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Benefits offered by this job

Medical, Dental, Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off from Day One

403-B Retirement Plan

4 Weeks 100% Paid Parental Leave

Career Development

Whole Person Well-being Resources

Mental Health Resources and Support

Pet Benefits

Job summary

Texas Health Huguley is seeking an experienced discharge planning/UM professional to join our team. You will actively participate in multidisciplinary rounds, educate patients and families, assess readmissions, and organize care conferences to ensure timely transitions.

The role requires RN licensure, 2+ years of hospital nursing, and knowledge of CMS discharge planning requirements. Strong communication, organizational, and EMR skills are essential. Full-time day shift; benefits included.

Qualifications

RN license required.
Associates degree in nursing required.
Bachelor's degree in nursing preferred.
Minimum 2+ medical/hospital nursing experience required.
Prior Care Management/Utilization Management experience preferred.

Responsibilities

Actively participates in multi-disciplinary rounds to review changes in patient status, progression and level of care, and discharge plans for all assigned patients to identify resources necessary at discharge and ensure a timely transition, escalating care delays to leadership as appropriate.
Educates patients and families regarding emotional, social, and financial impacts of illness and mobilizes family/community resources to meet identified needs while advocating for patient and family empowerment in making health care decisions and accessing needed services.
Assesses readmitted patients for the patient’s and family’s perceived reasons for the readmission.
Organizes and facilitates patient and family care conferences with the multidisciplinary team.
Documents discharge planning evaluation, ongoing assessment, discharge plans, MDRs, barriers to progression of care, avoidable days, and patient and family needs according to standard work. Communicates with Payors patient’s needs for authorization for post-acute care as needed.
Assesses patients’ and families’ wholistically for discharge planning needs in the inpatient, observation and/or emergency departments, including prior functioning, support systems, financial, and psychosocial in a timely fashion to avoid delays in discharge planning.
Reviews the medical record, including medications, history and physical, labs, and progress notes and incorporates the clinical, social, and financial factors into the transition of care plan.
Develops discharge plans with appropriate contingency plans throughout the hospital stay to ensure timely care coordination and progression of care, making arrangements for post-acute care services and facilities as well as community care for social needs.
Leverages technology and follows standard work and best practices to communicate with post-acute care services and facilities to ensure patient care information is communicated for continuity of care, medical records are complete, and discharge reconciliation is accurate.
Other duties as assigned.

Skills

Leadership

Data analysis

Critical thinking

Multitasking

Customer service

Communication

Organizational skills

Outlook

EMR proficiency

Flexibility

Community resources

CMS Conditions of Participation

Teamwork

Education

Associates of Nursing

Bachelors of Nursing (preferred)

Tools

Outlook

Electronic Medical Records (EMR)

Job description

Our promise to you:

Joining Texas Health Huguley is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. Texas Health Huguley is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
Paid Time Off from Day One
403-B Retirement Plan
4 Weeks 100% Paid Parental Leave
Career Development
Whole Person Well-being Resources
Mental Health Resources and Support
Pet Benefits

Schedule: Full time

Shift: Day (United States of America)

Address: 11801 SOUTH FWY

City: BURLESON

State: Texas

Postal Code: 76028

Job Description:

Actively participates in multi-disciplinary rounds to review changes in patient status, progression and level of care, and discharge plans for all assigned patients to identify resources necessary at discharge and ensure a timely transition, escalating care delays to leadership as appropriate.
Communicates with and educates patients and families regarding emotional, social, and financial impacts of illness and mobilizes family/community resources to meet identified needs while advocating for patient and family empowerment in making health care decisions and accessing needed services.
Assesses readmitted patients for the patient’s and family’s perceived reasons for the readmission.
Organizes and facilitates patient and family care conferences with the multidisciplinary team.
Documents discharge planning evaluation, ongoing assessment, discharge plans, MDRs, barriers to progression of care, avoidable days, and patient and family needs according to standard work. Communicates with Payors patient’s needs for authorization for post-acute care as needed.
Assesses patients’ and families’ wholistically for discharge planning needs in the inpatient, observation and/or emergency departments, including prior functioning, support systems, financial, and psychosocial in a timely fashion to avoid delays in discharge planning.
Reviews the medical record, including medications, history and physical, labs, and progress notes and incorporates the clinical, social, and financial factors into the transition of care plan.
Develops discharge plans with appropriate contingency plans throughout the hospital stay to ensure timely care coordination and progression of care, making arrangements for post-acute care services and facilities as well as community care for social needs.
Leverages technology and follows standard work and best practices to communicate with post-acute care services and facilities to ensure patient care information is communicated for continuity of care, medical records are complete, and discharge reconciliation is accurate.
Other duties as assigned.

Knowledge, Skills, and Abilities:

Leadership skills [Required]
Process and Outcome data analysis skills [Required]
Critical thinking and problem-solving skills [Required]
Ability to manage multiple tasks and prioritize levels of importance [Required]
Customer service skills [Required]
Ability to work and communicate with people of all social, economic, and cultural backgrounds; be flexible, open-minded and adaptable to change [Required]
Effective organizational skills [Required]
Computer proficiency with Outlook e-mail and electronic medical records [Required]
Flexible in a complex and changing healthcare environment [Required]
Knowledge of community resources and post-acute care programs across the continuum [Required]
Knowledge of clinical and social factors that affect the patient's functional status at discharge [Required]
Knowledge of CMS Conditions of Participation for Discharge Planning [Required]
Conflict management and resolution skills [Required]
Teamwork principles [Required]