RN Case Manager - Weekends

CP01 Carilion Medical Center; Roanoke (VA); On-site; USD 76,689 - 115,044; Full time

Benefits offered by this job

Comprehensive Medical, Dental, & Vision Benefits

Paid Time Off

Employer Funded Pension Plan

Job summary

CP01 Carilion Medical Center in Roanoke, Virginia, is seeking a Registered Nurse Case Manager to perform patient assessments, coordinate care, and ensure smooth discharges. You'll engage with interdisciplinary teams, manage healthcare transitions, and maintain effective communication throughout.

The ideal candidate holds a Bachelor's degree in Nursing and has extensive experience in patient care management. The position offers a competitive salary and comprehensive benefits including medical and wellness programs.

Qualifications

• Must be a licensed Registered Nurse in Virginia with five years RN experience preferred.
• Three years of recent clinical experience managing patient care required.
• Strong communication and teamwork skills are essential.

Responsibilities

• Perform patient needs assessments to improve care coordination.
• Promote team collaboration for effective discharge planning.
• Ensure compliance with regulations during discharge processes.

Skills

Interdisciplinary collaboration

Patient assessment

Discharge planning

Utilization management

Effective communication

Education

Bachelor's degree in Nursing

Tools

InterQual software

Predictive analytic software

Job description

How You’ll Help Transform Healthcare

• Perform patient needs assessments upon admission and at regular intervals to facilitate referrals and provide linkages to health, wellness, and post‑acute care resources across the health care continuum.
• Promote interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan, and to ensure appropriate length of stay, resource management, and care transitions to the next level of care.
• Comply with all federal and state regulations surrounding the discharge process and with CMS regulations related to discharge planning documentation.
• Possess knowledge of growth and development appropriate to the age group served and incorporate that knowledge into the plan of care.
• Collaborate with the Utilization Review Nurse, maintaining regular contact throughout the day and reviewing assigned census with the SW partner to determine patient statuses and needs.
• Use InterQual software to support accurate patient statuses according to ongoing medical necessity.
• Aid in the delivery of regulatory letters and patient notices related to insurance coverage/non‑coverage, using support staff as appropriate.
• Ensure documentation accurately reflects the patient’s condition, co‑morbidities, treatments, and procedures that support the most appropriate admission status and DRG assignment.
• Communicate with patients/families to ensure understanding of the financial implications of discharge plans and provide medication assistance (RX Help, CMAP).
• Facilitate an interdisciplinary approach to patient care and actively participate in Interdisciplinary Team Meetings on assigned units, sharing meaningful and professional knowledge about the patient’s progress or barriers to the plan.
• Provide feedback to the health care team verbally and via chart entries regarding the patient’s progress toward expected outcomes and manage changes to the plan as necessary.
• Maintain effective communications with all disciplines to promote timely and appropriate discharges; maintain daily communication with Social Work and Utilization Review, including case reviews and morning touchpoints.
• Coordinate care and services within the case‑managed population; perform face‑to‑face assessments of patients/families when appropriate to identify individualized needs.
• Document in the medical record in the appropriate time frame, accurately reflecting the plan of care and interventions provided by the case manager.
• Coordinate referrals of post‑acute services such as home health, hospice, and durable medical equipment (DME), and facilitate appropriate referrals surrounding high‑cost medications for all patients.
• Work with other disciplines and support staff to obtain prior authorizations and/or co‑pay information to ensure medication needs are met for discharge and do not create a barrier.
• Ensure coordination of care when patients are transferred (acute hospital to acute hospital, and jails/prisons) and communicate with outside nursing or case‑management staff as appropriate for smooth transitions.
• Advocate for the patient and family throughout the entire episode of care and participate in departmental and system performance improvement initiatives.
• Contribute to Carilion Clinic’s performance improvement activities by engaging with predictive analytic software, collecting and analyzing relevant patient care and fiscal data, and evaluating the effect of case management on quality outcomes and fiscal parameters.
• Comply with all departmental policies and practices and foster teamwork and professionalism.

Summary List of Daily Tasks / Expectations of the RN Case Manager Role

• Participate in unit‑based IDR morning and afternoon huddles.
• Coordinate referrals for DME, HH, hospice.
• Utilize predictive analytic software (e.g., JVION).
• Complete face‑to‑face patient assessments.
• Communicate with assigned UR nurse and SW partner.
• Reassess patients and document status of referrals, movement on barriers.
• Aid in the delivery of regulatory letters (IM, HINN).
• Integrate InterQual information during unit huddles and throughout the workday.
• Provide medication assistance to patients identified in need (RX Help, CMAP).
• Initiate medication investigations (need for authorization, obtain co‑pay information).
• Communicate post‑acute care needs of inmates during transitions back to jail.
• Assist in acute‑acute and transitions of care.
• Maintain awareness and anticipate unit‑based patient needs.
• Provide hand‑off communication of unit needs to peers during weekday/weekend transitions.

What We Require

Education: Registered Nurse. Bachelor’s degree required. Five years of RN experience in a hospital setting may be considered in lieu of a bachelor’s degree.

Experience: Three years of recent clinical experience with responsibilities reflecting direct management of patient care, including planning, coordination, and delivery of services such as education, psychosocial support, discharge planning, and utilization management. Supervisory or leadership experience is preferred.

Licensure, certification, and registration: Current licensure in Virginia as a Registered Nurse. AHA BLS‑HCP required within 6 months of hire.

Other Minimum Qualifications: Demonstrated knowledge and competency in orientation completion; positive interpersonal oral and written communication skills; integrity; innovation; teamwork; courtesy; problem resolution; customer‑focused service delivery; willingness to work as an integral member of a multi‑skilled team; computer literacy; community and system resources; effective interpersonal relations; assertiveness; flexibility; perseverance; diplomacy and negotiation.

Compensation Range: $76,689.60 – $115,044.80. Employee pay is based on a variety of factors, including qualifications, credentials, education, and prior work experience. The range does not include benefits or pension plan.

Benefits, Pay and Well‑being at Carilion Clinic

• Comprehensive Medical, Dental, & Vision Benefits
• Employer Funded Pension Plan, vested after five years (Voluntary 403B)
• Paid Time Off (accrued from day one)
• On‑site fitness studios and discounts to Carilion Wellness centers
• Access to our health and wellness app, Personify Health
• Discounts on childcare
• Continued education and training

Carilion Clinic is an Equal Opportunity Employer: We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age (40 or older), disability, genetic information, or veterans status. Carilion is a Drug‑Free Workplace.

For more information on E‑Verify: https://www.carilionclinic.org/eoe-e-verify-and-right-work-policies