Case Management RN (Full Time) (Healthcare)

Job Summary

Oversees the transition of the patient through the healthcare spectrum from admission to discharge ensuring optimal level of wellness. Enhances care coordination through planning, assessing, re-assessing, implementing, monitoring, and evaluating care options and services to meet the individual plan of care needs for the pediatric patient through Utilization Resource Management, Transition of Care, Discharge Planning, and Care Management. 

Job Specific Duties

• Transitions care to external providers, community partners, and services to achieve quality outcomes for the patient and family.
• Facilitates efficient care transitions for the pediatric patient through defining discharge and transition of care criteria through an individualized patient centered plan of care.
• Conducts initial assessment of the patient and family within 24 hours to identify potential transition of care and discharge barriers and needs.
• Develops a relationship with patients and families to partner for safe transition of care through the healthcare spectrum.
• Collaborates with the inter-professional team to implement safe and timely transition and discharge planning. Proactively identifies, and resolves delays and obstacles for safe discharge.
• Coordinates and facilitates inter-professional team meetings, advocating on behalf of the patient, focusing on the transition needs of the patient.
• Drives and actively participates in case management and unit specific conferences with Medical Director to facilitate transition of care through discussion and identification of complex cases.
• Develops and implements a patient centered specific plan of care and makes referrals based on the needs assessment & available resources in conjunction with members of the inter-professional team.
• Coordinates medical discharge planning needs specific to pediatric patients including medication authorization, DME, supplies, home health nursing & inpatient/outpatient rehab, etc.
• Screens charts to determine admission and concurrent level of care criteria; monitors daily plan of care.
• Collaborates to eliminate barriers of efficient delivery of care in appropriate setting, LOS, and readmission prevention.
• Coordinates with health care team to assess & identify issues/needs that may impact on transition of level of care & discharge. Applies cost benefit analysis when planning for discharge needs.
• Collaborates with family, health care team, payers, providers, & community partners to achieve appropriate resource management to implement safe transition and discharge plan established.
• Assists in identifying variances in utilization of resources & avoidable days/denials. Collaborates with Utilization Management RN, Appeals Management, & Medical Director in the appeals process.
• Responsible for the appropriate use of software and applications when available and enters case management information accurately and in a timely manner.
• Participates in departmental initiatives/opportunities for improvement through departmental and unit council assignments, including interdisciplinary rounds and LEAN projects.

Minimum Job Requirements

• RN - Registered Nurse RN Licensure within the State of Florida or Multi-State Enhanced Nursing License Compact (eNLC) – maintain active and in good standing throughout employment
• 1-3 years pediatric or adult acute clinical hospital experience.
• 1-3 year's experience in Case Management, designated/pediatric specialty, program/project development, Utilization Management, and/or Clinical Pathways.

Knowledge, Skills, and Abilities

• BSN degree or currently enrolled in BSN program highly preferred.
• National Certification in Case Management through an accredited body preferred.
• Experience in discharge planning, clinical pathways, and continuous quality improvement highly desirable.
• Leadership experience is highly preferred.
• Basic proficiency in Microsoft Word, Excel, and Outlook.
• Able and available to work a flexible/rotating schedule including holidays and weekends.
• Able to communicate effectively both verbally and in writing in a clear, concise, and courteous manner.
• Fluent in Spanish preferred.
• Working experience with various technologies, hospital information systems, and other tools used in patient financial services, particularly Cerner.
• Able to interpret, adapt, and react calmly under stressful conditions in a pleasant manner.
• Able to relate cooperatively and constructively with customers and co-workers.
• Able to maintain confidentiality of sensitive information.
• Able to establish necessary professional relationships and interact effectively with internal and external customers.
• Able to work in a fast paced environment and effectively manages and uses resources to successfully meet the competing deadlines of a variety of tasks, problems, and projects.
• Able to use logical and analytical thinking to interpret technical data and solve a broad range of problems.
• Able to work independently when interacting with organization's clinical and non-clinical customers and outside vendors/payors.