RN Case Manager

NCH; Naples (FL); On-site; USD 70,000 - 90,000; Full time

Job summary

NCH Healthcare System, Inc. in Naples, FL seeks an RN Case Manager to advocate for patients, families and caregivers while coordinating care across the health system. The role supports the development of the plan of care and efficient throughput.

Responsibilities include discharge planning, utilization review, and collaborating with the care team to ensure appropriate resources and safe transitions. Requires Florida RN license, 1 year in discharge planning or case management, and BLS

Qualifications

• Associate Degree in Nursing required; BSN preferred.
• Minimum of 1 year discharge planning, case management, managed care, or RN experience in a medical setting.
• Licensed as a Registered Nurse (RN) in Florida.
• Basic Life Support (BLS) certification required from the American Red Cross or American Heart Association.

Responsibilities

• Screen patients for clinical, psychosocial, financial, and other factors and collaborate with patients/families in goal setting.
• Evaluate patient/family understanding and engagement with progress toward goals and update the plan of care.
• Arrange services among community agencies, providers, and others involved in the plan of care.
• Provide patient/family with resources and tools to make informed choices.
• Develop a clinically appropriate care plan aligned with patient goals and available resources.
• Facilitate communication for handovers and ensure all transition elements are implemented.

Skills

Discharge planning

Case management

Patient advocacy

Collaboration

Education

Associate Degree in Nursing

BSN preferred

Tools

BLS Certification

Job description

US:FL:Naples:350 7th Street North | RN | Full Time

Description

• DEPARTMENT: 17170 - Case Management


• LOCATION: 350 7th Street North, Naples, FL, 34102


• WORK TYPE: Full Time


• WORK SCHEDULE: 8 Hour Day

ABOUT NCH

NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.

NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.

Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.

JOB SUMMARY

The RN Case Manager serves as a patient advocate to support, guide and coordinate care for patients, families, and caregivers as they navigate their health and wellness journeys. The RN Case Manager is responsible for participating in the development of the patient's plan of care and facilitating efficient throughput, ensuring appropriate utilization of resources, identifying needs, and establishing safe and appropriate discharge plans.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Other duties may be assigned.

• Screen all patients for clinical, psychosocial, financial, and other factors that may affect the progression of care and collaborate with patients/families/caregivers in goal setting that is reflective of the patient’s needs.


• Evaluates the patient’s/family's/caregiver’s level of understanding and engagement with the progress toward goals and incorporates findings into the plan of care.


• Arranges services among community agencies, provider, patient/family/caregivers, and others involved in the plan of care.


• Provides patient/family/caregivers available tools/ resources including pertinent quality measures to make informed choices.


• Develops a plan that is clinically appropriate and focused on the patient’s care needs and goals for care and treatment plan is consistent with patient choice and available resources.


• Facilitate bi-directional communication to enhance the handover of care from one setting and arrange/ensure all elements of the transition plan are implemented and communicated to key stakeholders including, not limited to, the health care team, patient/family/caregiver, payers, and post-acute providers.


• Identify available community resources/potential partners and advocate for resolution of gaps in the available resources and processes.


• Maintain knowledge of and ensure compliance with the federal, state, local organization and accreditation requirements that not only impact their scope of services but affect their ability to advocate for the patient.


• Ensure the patient is in the appropriate status, level of care and length of stay for the patient’s clinical condition and participates in multidisciplinary rounds with the care team.


• Follows through with appropriate intervention and documentation to facilitate discharge when a patient fails to meet medical necessity.


• Identify and address avoidable delay practice patterns that may require modification to support cost-effective care. Uses escalation process as needed.


• Educates patients/families/caregivers on the financial impact of their care options.


• Tracks avoidable delays/days as well as over/under utilization of resources.


• Provide the clinical information necessary for the appeals process of cases for which a denial of care or services has been received.


• Proactively prevent medical necessity denials by providing education to physicians, staff and patients, interfacing with payers and documenting relevant information.


• Participate in the development of performance improvement activities relevant to identified opportunities.


• Actively collaborates with utilization review team to facilitate and meet organizational and department goals.


• Recognizes situations that require referral to quality or risk management and makes a timely referral.

EDUCATION, EXPERIENCE AND QUALIFICATIONS

• Minimumof Associate Degree in Nursing required; BSN preferred.


• Minimum of 1 years Discharge planning, case management, managed care, or Registered Nurse experience in a medical setting.


• Licensed as a Registered Nurse (RN) in the state of Florida.


• Basic Life Support (BLS) certification required from the American Red Cross or American Heart Association.