RN Case Manager: Care Coordination & Discharge Lead

Cynet HealthStaff; Billings (MT); On-site; USD 70,000 - 95,000; Full time

Job summary

RN - Case Manager coordinates the care and services for patients identified as needing assistance or meeting Care Management criteria in an acute care setting. The role collects in-depth information to identify needs and develops a plan of care with patient and family.

Works with patient and family/caregivers to determine specific goals and actions based on assessment. Coordinates discharge planning and executes interventions to meet established goals, organizing resources to meet the plan.

Qualifications

• Must have hospital case management experience.
• Minimum of three (3) years as a Registered Nurse in an acute care setting.
• RN License in state of practice or compact state.
• ACM or CCM certification preferred.

Responsibilities

• Coordinates the care and services for patients identified as needing assistance or meeting Care Management criteria.
• Collects in-depth information about a patient's medical, functional, and social condition to identify individual needs in order to develop a plan to meet those needs.
• Works with patient and family/caregivers to determine specific goals and actions based on assessment.
• Coordinates discharge planning.
• Executes specific interventions to meet established goals.
• Organizes, integrates, and coordinates the necessary resources to accomplish the goals and plan.
• Assesses the patient’s prior level of functioning, access to and/or use of community resources, and available support systems.
• Assists the care team in developing a plan of care which includes, but is not limited to: assuring appropriateness of services and care setting, assuring individualized support and education, determining the need for continued services, planning for discharge, and identifying and connecting patients/families with available community resources if needed.
• Collaborates with physicians and other members of the healthcare team on the patient’s behalf.
• Identifies appropriate admission and continued stay issues.
• Enhances the quality of patient care through effective and efficient use of resources.
• Helps to identify strategies for reducing length of stay and appropriate utilization of services.
• Utilizes criteria including clinical pathway data and implements strategies to resolve controllable variances.
• Attends, facilitates, and participates in rounds and case conferences.
• Advocates for patient rights.
• Monitors efficiency and availability of services and evaluates outcomes through variance tracking and data collection.
• Identifies needs, facilitates, or provides education to physicians and ancillary departments/nursing units regarding case management, discharge planning process, and roles.
• Participates in multidisciplinary groups and development of guidelines.
• Promotes the mission, vision, and values of the organization and abides by service behavior standards.
• Performs other duties as assigned.

Skills

Case management

Clinical assessment

Discharge planning

Care coordination

Education

BSN

Job description

RN - Case Manager coordinates the care and services for patients identified as needing assistance or meeting Care Management criteria in an acute care setting. The role collects in-depth information to identify needs and develops a plan of care with patient and family.

Works with patient and family/caregivers to determine specific goals and actions based on assessment. Coordinates discharge planning and executes interventions to meet established goals, organizing resources to meet the plan.