RN Care Mgr UR Case Mgmt

JOB RELATIONSHIPS

Reports to the Director of Research and Innovation in collaboration with the CNO/VP of Patient Care Services

DEFINITION OF POSITION

The Registered Nurse (RN) Care Manager will: Conduct a comprehensive assessment and develop thoughtful plans to implement, coordinate, monitor, and evaluate healthcare services tailored to meet each individual's specific needs in a cost-effective manner. Perform utilization reviews to assess the appropriateness and medical necessity of healthcare services for patients, while fostering strong relationships with payers to ensure compliance and alignment. Foster strong relationships with payers to ensure compliance and alignment Act as a patient advocate to guide patients through the complex healthcare system, ensuring their preferences and rights are respected and helping them access appropriate care or coverage Facilitate coordinated patient care by collaborating with patients, their families, healthcare staff, physicians, Advanced Practice Provider (APPs) and community services, all aimed at promoting quality care. Incorporate cultural competence and awareness of Social Determinants of Health (SDOH) into assessment and care plan development to ensure a holistic approach to patient well-being Take the lead on discharge planning and care coordination initiatives, with the goal of minimizing readmissions. Work closely with interdisciplinary teams to create and refine patient-centered care plans. Regularly monitor key performance indicators (KPIs), such as length of stay and readmission rates, to ensure optimal service delivery. Uphold stringent adherence to guidelines established by CMS, the Joint Commission, and all relevant payer requirements.

QUALIFICATIONS

Professional Registered nurse with current North Carolina license (BSN preferred). Current BLS Healthcare Provider certification. Three years clinical experience in a health care facility with knowledge base of clinical nursing principles Case Management Certification (CCM), Accredited Case Manager (ACM) and/or Health Care Quality and Management (HCQM) certification preferred Knowledge of current trends and issues related to utilization and case management principles related to the hospital practice setting. Computer experience Evidence of participation in ongoing continuing education programs.