Case Management RN

Nemours is hiring a Nurse Case Manager.  The Nurse Case Manager (NCM)/Case
Management RN is responsible for the coordination of care of individual patients
in the Inpatient and Emergency Department acute care environment. Through the
use of the nursing process, patient care will be assessed, planned, implemented
and evaluated with consideration to the appropriate use of resources,
anticipatory discharge and timely progression of care.  The NCM will manage care
with a focus on designated clinical, operational, and financial outcomes for
aggregate patient populations. In collaboration with the interdisciplinary team
and a family-centered process, the NCM will work to improve outcomes as measured
by timely discharge from acute inpatient care, connection to post-discharge
care/appointments, family/caregiver access to needed supplies, reduced
readmission rates, and improved patient/family satisfaction.  Discharge
planning, transitions of care and outpatient care of patients within the

continuum of care will be aligned with

* American Case Management Association Standards of Practice and Scope of
Services (ACMA)
* American Case Management Association Transitions of Care (ACMA)
* Case Management Society of America Standards of Practice (CMSA)

The NCM is accountable for adherence to policies and procedures of Nemours
Children’s Hospital, Delaware, and other affiliated hospitals to which
Nemours-delegated patients are admitted/seek care. 

The NCM is expected to maintain all state and federal clearances for DE.

Qualifications

* Diploma/AD required; BSN preferred
* Active Registered Nurse license in the applicable state(s) (required) 
* Case management or utilization management certification (preferred)
* Minimum of five (5) years of progressive clinical experience, including
utilization management, case management, or related healthcare operations 

Primary Responsibilities

1. Assesses inpatient and Emergency Department patients for discharge planning
needs, social drivers of health, gaps in care, and access to post-acute
services and supplies (e. g., DME, home nursing).
2. Collaborates with providers, social work, and the interdisciplinary team to
develop and implement patient-centered plans of care and discharge plans,
with a clear timeline and estimated discharge date.
3. Monitors clinical progression and barriers to discharge; escalates issues to
support appropriate level of care, length of stay, and resource utilization.
4. Partners with Utilization Management to support medical necessity and
correct patient status (inpatient vs. observation/OPER); supports denial
prevention and appeals through timely, complete clinical documentation,
educating providers around medical necessity/denials, and support for peer
to peer reviews.
5. Identifies patients at risk for unsafe transitions, high ED utilization, or
readmission; completes transition assessments and coordinates follow-up care
and appointments.
6. Communicates with patients/families and the care team to address barriers,
coordinate services, and adapt plans based on changes in clinical status or
goals of care.
7. Provides patient/family education on the discharge process, including
follow-up needs, and medications/supplies; confirms understanding and
documents education as appropriate.
8. Initiates and coordinates referrals to internal and community resources to
support discharge needs (e. g., home health, DME, transportation, pharmacy).
Ensure timely and accurate delivery and fulfillment of discharge resources.
9. Coordinates transitions of care with outside hospital/facility case
management and care coordination teams, including discharge to home,
transfer to another acute care facility, home services, or skilled nursing
facility

Nemours Children's Health is an internationally recognized pediatric health
system serving more than 1.7 million patient encounters each year. We deliver
care across six states through two freestanding children’s hospitals — Nemours
Children's Hospital, Delaware and Nemours Children's Hospital, Florida — along
with a network of more than 80 primary, urgent, and specialty care practices and
more than 40 hospital partnerships.

Backed by the Nemours Foundation and Alfred I. duPont Trust, our $1.7B nonprofit
system is dedicated to improving children's health through clinical care,
research, education, advocacy, and prevention. Our Whole Child Health approach
focuses equally on prevention and treatment, partnering with communities to help
every child thrive.

Inclusion and belonging guide our strategy and growth. We are committed to
culturally relevant care, reducing health disparities, and fostering an
environment where every associate, patient, and family feels supported and
valued.

Learn more at Nemours.org [https://www.nemours.org].