Case Manager (RN) - PRN/Supplemental

Position Objective

The Case Manager works under the direction of the clinical director of care
management, providing coordination of care for patients at Luminis Health to
support safe, seamless, timely transitions across the continuum.  Utilizing a
collaborative process, will identify (using quantitative and qualitative
methods), assess, plan, implement and evaluate the options and services required
to meet an individual’s health and health related needs, including social-
determinants that affect ones’ overall wellbeing. Promotes the right resources,
at the right time and at the right level of care and is responsible for engaging
and supporting patients that are in need of care management services; is able to
determine, using evidence based guidelines, the correct initial and ongoing
level of care for patients and is able to submit appropriate denial review for
Medicare, Medicaid and commercial insurers.

Essential Job Duties

 Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.

 1. Identifies and prioritizes patient in need of care management services,
using a holistic approach inclusive of biopsychosocial, functional, cultural,
spiritual, and financial factors; uses a multi discoplinary approach to
assess/plan for care needs.

2. Identifies and implements strategies such as motivational interviewing to
promote patient engagement, self-care, treatment adherence, and optimal levels
of health and well-being.

3.  Utilizes evidenced based guidelines (such as InterQual or other agreed upon
evidenced based guidelines) to promote quality care, decrease variation and
mitigate waste. Verifies appropriate level of care; enters clinical review and
authorized days in Epic; documents actions to avoid denied days; refers cases to
Physcian Advisor as appropriate.

4. Manages observation stay patients assertively and ensures timely testing,
 treatment and conversion to inpatient status or discharge.  

5. Develops and coordinates transition plans for patients transitioned to home
with home health, community care coordination program, Hospice or Palliative
care, home infusion and routine sub-acute and skilled post-acute providers;
completes all necessary documentation and necessary handovers.  Involves and
prepares patients and families for transition from the ED, Peds, Clatanoff or
Observation unit as indicated. 

6. Maintains clear and concise documentation in each patient record to reflect
physical and functional limitations, psychosocial characteristics, educational
needs of patient & family, family/social support systems, financial, economic,
and transition needs. Initiates referrals to disciplines as indicated.

7. Participates in nursing unit and department clinical outcome projects as well
as process improvement initiatives of care management. 

8. Identifies potential or current patient situations which require referral to
other members of the health care team such as infection control, risk
management, or quality management.  Assures plan of care is adjusted as
appropriate and that follow-up occurs.  Keep leadership abreast of potential
issues.

9. Utilizes all risk and predictive analytic tools such as the readmission risk
tool.  Applies tailored interventions to mitigate potential barriers or risk,
prolonged unnecessary hospitalization and readmission prevention.   

10. Maintains compliance with all regulatory standards (CMS, commercial insurers
etc)

Educational/Experience Requirements

BSN or ADN with equivalent experience.  BSN must be achieved within 5 years of
start date in the role

Three years of experience in a clinical setting, ambulatory or post-acute.

Care coordination experience preferred.    

Licensure/Certification

Current  licensure as a registered nurse by the Maryland Board of Nursing.     

Working Conditions, Equipment, Physical Demands

There is reasonable expectation that employees in this position will be exposed
to blood-borne pathogens.

Physical Demands -  Medium work

The physical demands and work environment that have been described are
representative of those an employee encounters while performing the essential
functions of this position. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions in accordance
with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for
this position.  This document is not intended to be an exhaustive list
encompassing every duty and requirement of this position; your supervisor may
assign other duties as deemed necessary.

Pay Range

$35—$50 USD

Luminis Health Benefits Overview

• Medical, Dental, and Vision Insurance

• Retirement Plan (with employer match for employees who work more than 1000

• Paid Time Off

• Tuition Assistance Benefits

• Employee Referral Bonus Program

• Paid Holidays, Disability, and Life/AD&D for full-time employees

• Wellness Programs

• Employee Assistance Programs and more

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