Registered Nurse Case Manager (RN)

Job Summary 

Position is filled by a professional nurse who, as a result of education and in-depth clinical experience possesses the advanced clinical knowledge and skills necessary to provide case management to targeted populations. Responsible for coordinating and facilitating the patient’s hospitalization from pre-admission through post-discharge. Collaborates with physicians, nurses, social workers and other health team members to expedite medically appropriate cost effective care. Applies clinical expertise and medical appropriateness criteria to resource utilization and discharge planning achieve desired health maintenance and disease prevention outcomes. Will advise the health care team and provide leadership as necessary. Communicates at the inter-departmental level as well as across all health care areas with the goal of improving clinical management of patients thereby impacting medical and psychosocial care across the health care continuum. Core processes include risk assessment and management of clinical populations, discharge planning, and utilization management. 

• Using established criteria, reviews appropriateness of patient’s admission, need for continued stay, information needed for discharge. 
• Discuss estimated length of stay, treatment and discharge plan with the attending physician, as indicated 
• Initiate discharge planning by assessing the patient’s needs and documenting the assessment on the interdisciplinary plan of care. Interviews patient, family, and appropriate health team members to develop a discharge plan that incorporates patient choice, and is clinically appropriate, cost effective, and safe. 
• Ensure that the interdisciplinary care plan and the discharge plan are consistent with the patient’s clinical course, continuing care needs and covered services. 
• Refers complex discharge planning issues to other members of the case management team as directed by referral criteria. 
• Provides leadership to the health care team to implement the discharge plan and facilitate patient transfer to the next level of care when medically able. 
• Obtain from third party payer certification due to patient status change, information needed for discharge. 
• Conducts interdisciplinary rounds 
• Discuss with attending physician and/or physician advisor the appropriateness of resource utilization, consultation and treatment plan. 
• Collect data on variances from quality screening criteria by the Clinical Excellence Council. Report quality concerns to Quality Assurance. Continually ensure and enhance quality outcomes 
•  Respond to third party requests for concurrent clinical information. 
• Complete all necessary forms in a timely manner. 
• Act as a liaison/patient advocate and influence interactions to ensure high quality patient care. 
• Coordinate appropriate educational material/instruction for patients, families, medical staff, and multi-disciplinary personnel to accomplish patient care outcomes. 
• Maintain cost effective utilization of care continuum resources. 
• Coordinate with all staff necessary to develop a mechanism to monitor patient progress against guidelines and evaluate variances for individual patients and targeted populations. 
• Identify possible delays and avoidable days; work with providers to prevent delays and identify system/provider opportunities for improvement. 
• Other duties as assigned 

• Minimum Requirements 
  • Education: Associates degree in nursing or related field or equivalent combination of work experience and education 
  • Experience: Recent Acute care experience 
  • Licensure/Certifications:  
    • Valid current Arizona Nursing License or compact state license and ability to become Arizona Licensed in 30 days.  
    • Basic Life Support (BLS)  
    • American Heart Association Advanced Cardiac Life Support (ACLS) American Heart Association 
    • Pediatric Advanced Life Support (PALS)  
    • Crisis Prevention Institute (CPI)  
    • NIH Stroke Scale (NIHSS) and others as required by individual department. 
• Preferred Requirements 
  • Education: Bachelor's Degree in Nursing 
  • Experience: Combined bedside and care management experience 
  • Licensure/Certifications: Certification in specialty area, and/or Case Management 

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