Case Manager (RN) - PRN

Case Manager (RN)

Join our team at Doctors Community Medical Center in Lanham, MD, as a Case Manager (RN) in a PRN/Supplemental role. This position involves day shifts from 8:00 am to 4:30 pm, with rotating weekends.

Job Description

• Work under the direction of the clinical director of care management, providing coordination of care for patients to support safe, seamless, timely transitions across the continuum.
• Utilize a collaborative process to identify, 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 overall wellbeing.
• Promote the right resources at the right time and at the right level of care, engaging and supporting patients in need of care management services.
• Determine the correct initial and ongoing level of care for patients using evidence-based guidelines and submit appropriate denial reviews for Medicare, Medicaid, and commercial insurers.

Essential Job Duties

• Identify and prioritize patients in need of care management services using a holistic approach inclusive of biopsychosocial, functional, cultural, spiritual, and financial factors; use a multidisciplinary approach to assess/plan for care needs.
• Implement strategies such as motivational interviewing to promote patient engagement, self-care, treatment adherence, and optimal levels of health and well-being.
• Utilize evidence-based guidelines (such as InterQual) to promote quality care, decrease variation, and mitigate waste; verify appropriate level of care; enter clinical review and authorized days in Epic; document actions to avoid denied days; refer cases to Physician Advisor as appropriate.
• Manage observation stay patients assertively and ensure timely testing, treatment, and conversion to inpatient status or discharge.
• Develop and coordinate transition plans for patients transitioning to home with home health, community care coordination programs, hospice or palliative care, home infusion, and routine sub-acute and skilled post-acute providers; complete all necessary documentation and handovers.
• Maintain 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; initiate referrals to disciplines as indicated.
• Participate in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.
• Identify potential or current patient situations requiring referral to other members of the healthcare team such as infection control, risk management, or quality management; assure plan of care is adjusted as appropriate and that follow-up occurs; keep leadership abreast of potential issues.
• Utilize all risk and predictive analytic tools such as the readmission risk tool; apply tailored interventions to mitigate potential barriers or risks, prolonged unnecessary hospitalization, and readmission prevention.
• Maintain compliance with all regulatory standards (CMS, commercial insurers, etc.).

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.
• Current licensure as a registered nurse by the Maryland Board of Nursing.
• Adherence to the credentialing requirements of AAMC as stated in the nursing bylaws.

Working Conditions

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

Benefits

• Medical, dental, and vision insurance
• Retirement plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid time off
• Tuition assistance benefits
• Employee referral bonus program
• Paid holidays, disability, and life/AD&D for full-time employees
• Wellness programs
• Eligible for shift differentials/OT
• Employee assistance programs and more

Benefit offerings based on employment status.