RN Care Manager

GBMC HealthCare; Towson (MD); On-site; USD 85,000 - 110,000; Full time

Job summary

GBMC HealthCare is seeking an experienced Case Manager to oversee inpatient care coordination and discharge planning. The role requires collaboration with an interdisciplinary team to optimize patient outcomes and ensure quality, cost-effective care across the continuum.

The position emphasizes utilization review, payer coordination, and discharge planning, supporting the goal of efficient service delivery and optimized reimbursement while maintaining patient-centered care.

Qualifications

• Two years of case management experience including discharge planning.
• Diversified, progressive experience in acute care and/or other settings within the continuum preferred.

Responsibilities

• Assesses patients within a defined caseload to identify clinical status, needs, issues, financial resources, and care goals; demonstrates knowledge of reimbursement mechanisms.
• Continually assesses patient care management needs through frequent rounds and communication with physicians and other appropriate members of the health care team.
• 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.

Skills

Care management theories

Computer software

Oral & written communication

Critical thinking

Problem solving

Calm under pressure

Discharge planning

Education

BSN

ASN with BSN in progress

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.

Education

Bachelor 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) years

Experience

Two (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 preferred

Skills

• Knowledge of care management theories, principles, and standards
• Skill in using computer software programs
• Advanced skill in oral and written communication
• Advanced skill in critical thinking
• Ability to resolve complex problems
• Ability to remain calm under pressure and intense time constraints
• Ability to assess discharge needs for patients

Licensures, Certifications

• Current state of Maryland Registered Nurse license
• Bachelor of Science in Nursing (BSN) OR documentation of current enrollment in BSN program with expected graduation within three years of hire
• Care Management highly desired.

Physical Requirements

• Ability to sit, stand, stoop, and bend.

Working Conditions

• Primarily 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 Employment

Maryland RN licensure – current and ongoing

Reports to

DIRECTOR of Care Management

Patient & Workplace Safety

• Employee has knowledge and understanding of patient and workforce safety as it relates to job duties.

Patient Population

• Demonstrates 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