RN Case Manager - Weekends - Full time

Carilion Clinic; Roanoke (VA); On-site; USD 77,000 - 115,000; Full time

Benefits offered by this job

Comprehensive Medical, Dental, &Vision

Employer Funded Pension Plan

Paid Time Off (accrued from day one)

Onsite fitness studios and discounts

Job summary

Carilion Clinic in Roanoke, VA, is seeking an RN Case Manager for weekend shifts (Thurs-Sat, 7am-7pm) to support inpatient units. The role encompasses care coordination, discharge planning, and utilization management to optimize outcomes and costs.

You will collaborate with Social Work, UR, and interdisciplinary teams, perform needs assessments, and facilitate post-acute connections. A sign-on bonus and relocation assistance are available.

Qualifications

• RN with Bachelor's degree required.
• Three years of hospital-based clinical care including discharge planning.
• Current Virginia RN licensure; AHA BLS-HCP within 6 months.

Responsibilities

• Provide case management for assigned patient populations using InterQual guidelines.
• Promote cost-effective care by coordinating referrals and discharge planning.
• Perform patient needs assessments on admission and during stay.
• Coordinate with Utilization Review, Social Work, and care teams.
• Document plans and progress in the medical record per CMS requirements.

Skills

Case management

Communication

Interdisciplinary collaboration

Utilization review coordination

Education

Bachelor's degree in Nursing

Virginia RN license

Tools

InterQual software

CMS discharge planning

Job description

Requisition Number

R160315 RN Case Manager - Weekends - Full time (Open)

Employment Status

Full time

Shift

Weekends Only (United States of America)

Facility

1906 Belleview Ave SE - Roanoke

Requisition Number

R160315 RN Case Manager - Weekends - Full time (Open)

How You'll Help Transform Healthcare

**Sign on bonus and relocation assistance available**

Three 12 hour shifts: Thursday, Friday, Saturday, 7am-7pm

The RN Case Manager provides case management for assigned patient populations. Utilizes clinical expertise, communication and problem-solving skills to achieve optimal clinical and resource outcomes. Promotes cost-effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization. Performs patient needs assessments upon admission and at regular intervals, facilitating referrals and providing linkages to health, wellness, and post-acute care resources across the health care continuum. Promotes interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan. Promotes appropriate length of stay, resource management, and care transitions to the next level of care. Must comply with all federal and state regulations surrounding the discharge process. Must possess knowledge of growth and development appropriate to age group served and incorporate plan to meet needs into plan of care.

The RN Case Manager provides case management for assigned patient populations. Utilizes clinical expertise, communication and problem-solving skills to achieve optimal clinical and resource outcomes. Promotes cost-effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization. Performs patient needs assessments upon admission and at regular intervals, facilitating referrals and providing linkages to health, wellness, and post-acute care resources across the health care continuum. Promotes interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan. Promotes appropriate length of stay, resource management, and care transitions to the next level of care. Must comply with all federal and state regulations surrounding the discharge process. Must possess knowledge of growth and development appropriate to age group served and incorporate plan to meet needs into plan of care.

• Collaborates with Utilization Review Nurse.
• Maintains regular contact with assigned Utilization Review Nurse throughout the day.
• Uses InterQual software to support accurate patient statuses according to ongoing medical necessity.
• Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non-coverage, using support staff as appropriate.
• Ensures documentation accurately reflects the patient’ s condition, co-morbidities, treatment and procedures that support the most appropriate admission status and DRG assignment.
• Communicates with patients/families to ensure understanding financial implications of discharge plans
• Facilitates an interdisciplinary approach to patient care.
• Actively participates in Interdisciplinary Team Meetings on assigned units, sharing meaningful and professional knowledge to the team discussion regarding progression of care.
• Provides feedback to the health care team verbally and via chart entries regarding the patient’ s progress toward reaching expected outcomes or about barriers to the plan. Manages changes to the plan as necessary.
• Maintains effective communications with all disciplines to promote timely and appropriate discharges.
• Daily communication with Social Work and Utilization Review: includes case reviews, morning touchpoints, and ongoing throughout the workday.
• Coordinates care and services within the case managed population.
• Performs face-to-face assessments of patients/families when appropriate to identify individualized needs in collaboration with SW. CM will review assigned census beginning each day with their SW partner to determine patient statuses and needs for the day.
• Documentation in the medical record is completed in the appropriate time frame, accurately reflecting the plan of care and CM interventions. Complies with CMS regulations related to discharging planning documentation.
• Coordinates referrals of post-acute services such as home health (HH), hospice, and durable medical equipment (DME). Directs liaison activities to appropriately integrate with the patient and into the health care continuum.
• Facilitates appropriate referrals surrounding high-cost medications for all patients, insured or uninsured. Works with other disciplines along with 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.
• Ensures coordination of care when patients are transferred: acute hospital to acute hospital, and jails/prisons. Communicates with outside nursing or case management staff as appropriate for smooth transition.
• Advocates for the patient and family throughout the entire episode of care.
• Participates in departmental and system performance improvement Initiatives.
• Contributes to Carilion Clinics performance improvement activities by engaging with predictive analytic software.
• Collects and analyzes relevant patient care and fiscal data.
• Analyzes and evaluates the effect of case management on quality outcomes and fiscal parameters.
• Complies with all departmental policies and practices and fosters teamwork and professionalism.
• Summary List of Daily Tasks / Expectations of the Nurse Case Manager Role
• Participate in Unit-based IDR morning and afternoon huddles
• Coordinate referrals for DME, HH, Hospice
• Utilize predictive analytic software (example: 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
• Aids in the delivery of regulatory letters (IM, HINN)
• Integrates InterQual information during unit huddles and throughout workday as appropriate
• Provides Medication Assistance to patients identified in need (RX Help, CMAP) Initiates 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. 5 years of RN experience in a hospital setting may be considered in lieu of a bachelor's degree.

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

Licensure, certification, and/or registration: Current licensure in Virginia as a Registered Nurse.

Life Support: AHA BLS-HCP required within 6 months of hire.

Other Minimum Qualifications: Must demonstrate knowledge and competency in the following areas: satisfactory completion of orientation; positive interpersonal oral communication skills; effective written communication skills; integrity; innovation; team player; courteous; ability to resolve complaints/problems; customer-focused philosophy of service delivery; ability; willingness to work as an integral member of a multi-skilled team. Also demonstrate knowledge and competency in; computer literacy; community and system resources; effective interpersonal relations; assertiveness; flexibility; perseverance; diplomacy and negotiation.

This job description is only meant to be a representative summary of the major responsibilities and accountabilities performed by the incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

Compensation Range

$76,689.60 - $115,044.80

Benefits, Pay And Well-being At Carilion Clinic

Carilion understands the importance of prioritizing your well-being to help you develop and thrive. That's why we offer a well-rounded benefits package, and many perks and well-being resources to help you live a happy, healthy life - at work and when you're away.

Benefits

• Comprehensive Medical, Dental, & Vision Benefits
• Employer Funded Pension Plan, vested after five years (Voluntary 403B)
• Paid Time Off (accrued from day one)
• Onsite fitness studios and discounts to our 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 or for individuals with disabilities needing special assistance with our online application process contact Carilion HR Service Center at 800-599-2537, 8:00 a.m. to 4:30 p.m., Monday through Friday.

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

For more information, contact the HR Service Center at 1-800-599-2537.