RN CASE MANAGER: University Hospital (Care Management)

University Of Michigan

Ann Arbor (MI)

On-site

USD 6,199,000 - 9,643,000

Full time

4 days ago

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Benefits offered by this job

Evening Shift Differential

Night Shift Differential

Charge Nurse Differential

Tuition and Certification support

Job summary

University Hospital in Michigan Medicine is seeking an RN Case Manager in Care Management to coordinate comprehensive care plans for patients in inpatient and ED settings. You will collaborate with physicians, social workers and the interdisciplinary team to balance clinical needs with resource utilization.

The role emphasizes discharge planning, regulatory review and cost-effective care, with opportunities to lead care transitions and optimize LOS while ensuring high-quality patient outcomes.

Qualifications

Require nursing degree and Michigan RN licensure.
Minimum 3 years acute care RN or 3 years care management experience.
One year in nursing management or case management preferred.

Responsibilities

Coordinate care across inpatient and ED settings.
Lead discharge planning and referrals to homecare/infusion services.
Review admissions for utilization and payer authorizations.
Collaborate with interdisciplinary team to optimize length of stay and care transitions.
Maintain and report on care management metrics using clinical software.

Skills

Interdisciplinary collaboration

Communication skills

Organizational skills

Time management

Autonomy

Education

Bachelor's degree in Nursing

Associate degree or Diploma in Nursing with Masters in Nursing

Michigan RN licensure

Tools

Allscripts

InterQual

Job description

RN CASE MANAGER: University Hospital (Care Management)

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Job Summary

The RN Case Manager assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. The position is unique in that it combines clinical/quality considerations with regulatory/financial/utilization review demands.
The position creates a balance between individual clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes.
Organizational Relationships
The RN Case Manager reports directly to the Manager of Care Management.
The RN Case Manager works closely with the unit-based MPLAN team in reaching unit and organization goals including length of stay, care transitions, readmissions, and other quality initiatives. In the emergency departments, the RN Case Manager works collaboratively with other members of the interdisciplinary team to develop and implement a comprehensive, integrated discharge plan from the emergency department(ED). The RN Case Manager will recommend and document patient classification of all admissions utilizing established criterion set.

Responsibilities*

Characteristic Duties and Responsibilities

Care Coordination and Discharge Planning

Within 24 hours of admission interview each patient/family for anticipated needs post hospitalization
Develop plan for the day and plan for the stay with providers, patient and nursing staff
Lead daily care coordination rounds to update the plan and facilitate implementation.
Initiate discharge plan including early referrals to homecare, DME and infusion services
Prepare patient/family for discharge
In collaboration with SW partner follow standard for routine patient/family conference
Ensure patient handovers to next level of care; work closely with Care Navigators in clinics, complex care Case Managers , homecare and sub-acute liaisons
Support nursing Model of Care by working closely with nursing managers and staff to achieve Patient Family Centered Care goals: respect and dignity, information sharing, participation and collaboration
Facilitate increased volume of cases discharged by noon to improve capacity management
Collect avoidable days information; report findings in care management software, such as Allscripts
Participate in venues to reduce barriers to discharge

Utilization Review and Utilization Management

Conduct clinical review on admission; review every 3 days or as requested by payer
Determine patient classification with provider and ensure all patients placed in observation classification are notified; For inpatient to observation cases, ensure Condition Code 44 billing requirements are met
Communicates with third party payers to obtain necessary authorization for reimbursement of services.
Obtain anticipated LOS from provider and ensure patient and multi-disciplinary team is aware
Refer defined cases for medical secondary review and share findings with providers
Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials; input into appeals; share findings with providers
Review all cases with readmission within 30 days; report findings in Care Management software such as Allscript
Identify opportunities for cost reduction and participate in appropriate utilization management venues
Conducts referrals and consultation with Physician Advisor

Professional Development

Actively participates in the performance planning, competency and individual development planning process
Maintains current knowledge of case management, utilization management, and discharge planning , as specified by federal, state, and private insurance guidelines

Expectations of the position:

Knowledge of community resources to coordinate safe discharge from the emergency departments
Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, across disciplines
Excellent communication and negotiation skills as demonstrated in oral and written forms
Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external
Organizational and time management skills, as evidence by capacity to prioritize multiple tasks

Required Qualifications*

Required Educational Requirement; applicant must meet one of the following:Bachelors degree in Nursing ORan Associates degree or Diploma in Nursing with a Masters degree in Nursing

Current State of Michigan Board of Nursing licensure

Minimum of three (3) years of acute care RN nursing experience OR 3 years care management of acute care patients.

A minimum of one (1) year of successful experience in at least one of the following classifications: nursing management ( supervisor or higher) ; case management; demonstrated advancement in clinical career ladder ( advancement from level C to level D or higher )

NOTE: In order to be considered for this position the applicant must have met or will have met all the required qualifications prior to the start date of employment.

RESUME REQUIRED ( for both internal & external applicants ):

You must attach a complete and accurate resume to be fully considered for this position.

Desired Qualifications*

Two (2) years hospital discharge planning experience
Masters degree in nursing or other health related field
Case Management Certification such as ACM or CCM
Excellent analysis and data management and PC skills
Ability to work in autonomous and self-directed manner
Experience with InterQual criterion set
Experience with Allscripts
Experience with quality improvement initiatives
Two (2) years home care or skilled home health experience

Nursing Specific Info

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan medicine is comprised of over 26,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.

What Benefits can you Look Forward to?

Nursing at Michiganoffers a competitive salary with excellent benefits!

Hourly range for RSAM Competent, Registered Nurses $44.83-$69.71/ hour

Evening Shift Differential-$3.00 / hour
Night Shift Differential- $4.00 / hour
Charge Nurse Differential- $1.00 / hour

The benefit package includes:

Excellent medical, dental and vision coverage
2:1 Match on retirement savings and immediate vesting
Robust Tuition and Certification support programs
Large offering of no cost CEs and professional development for advancement

Nursing Specific Info

Salary & Nursing Framework Level:
This UMPNC RN posting is posted under the Role-Specific Advancement Model (RSAM) as:
RN Case Manager- COMPETENT NE

Actual RSAM LEVEL and salary will be determined at time of hire.

RSAM levels range from RN Case Manager-COMPETENT NE to RN Case Manager-EXPERT NE TO RN Case Manager-MASTERY NE to RN Case Manager- Mastery Plus NE.

Nursing Specific Info

Required qualifications must be met by the candidate in order to be interviewed and considered for the position.
Posting may be filled after the initial 5-day posting period.
Applicants who have left the UMPNC bargaining unit must include on their resume dates of past employment including months and years of service along with effort. Positions less than 20 hours/week may be combined.

Modes of Work

Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes here .

Work Schedule

Hours: 40
Shift: Day shift, 8am-4:30pm,with weekend and holiday commitments
Location: UMH Care Management

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

U-M EEO Statement

The University of Michigan is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants, including protected veterans and individuals with disabilities.

Job Title

RN CASE MANAGER COMPETENT-NE

Work Location

Michigan Medicine - Ann Arbor

Modes of Work

Onsite

Full/Part Time

Full-Time

Regular/Temporary

Regular

FLSA Status

Nonexempt