Registered Nurse (RN)-Hospital Case Manager, PRN, Days
Company: Prisma Health
Location: Greenville
Posted on: October 3, 2024
Job Description:
Inspire health. Serve with compassion. Be the difference.Job
SummaryThe Hospital Case Manager (HCM) provides case management
service for hospital patients, including, but not limited to,
utilization management to ensure efficient, cost-effective patient
progression through the continuum of care and discharge to an
appropriate level of care. In collaboration with physicians, leads
the multidisciplinary team including clinical staff and payors to
ensure efficient delivery of quality, cost-effective
care.Accountabilities
- Participates in discharge planning activities for patients with
complex medical issues, in order to ensure a timely discharge and
to provide appropriate linkage with post-acute care providers.
Accountable for appropriate levels of care and length of stay focus
- 10%
- Consults with interdisciplinary team, Physician Advisor and
administrative leadership as necessary to resolve barriers
regarding progression of care. Collaborates with physicians
throughout hospitalization, develops an effective working
relationship, and provides expertise regarding payor and regulatory
guidelines. - 10%
- Addresses and resolves system problems impeding diagnostic or
treatment progress. Proactively identifies and resolves delays and
obstacles during the hospital discharge planning process. Monitors
the patient progress, intervening as necessary and appropriate to
ensure that the plan of care and services provided are patient
focuses, high quality, efficient, and cost effective. - 10%
- On the basis of preliminary risk screening, assesses patients'
and family's psychosocial risk factors through evaluation of prior
functioning levels, appropriateness and adequacy of support
systems, reaction to illness and ability to cope. - 10%
- Advocates for patient and family empowerment and independence
to make autonomous health care decisions and access needed services
within the health care system. - 10%
- Maintains expert level knowledge of body systems and expected
clinical outcomes for patient disease process. Maintains current
knowledge of changes in state and federal regulatory requirements
related to the provision of case management services in a tertiary
acute care setting. - Maintains case management knowledge to
provide services in accordance with standards of practice as
established by department and management. - 10%
- Uses established clinical guidelines for initial/admission and
continued stay reviews for patients within assigned unit to ensure
medical necessity, appropriate level of care and timely
implementation of plan of care in accordance with hospital(s)
Utilization Review Plan. - 10%
- Promotes effective and efficient utilization of clinical
resources, ensuring quality, cost effective care. - - Provides
timely clinical reviews to third party payors. Responds to requests
for additional information within 24 hrs or next business day. -
10%
- Ensures that patient goals are set with patient/family,
negotiates healthcare resources and educates patient/family
regarding options of care throughout the continuum. Monitors
patient's progress and intervenes as necessary to ensure delivery
of quality, efficient, cost-effective services. - 10%
- Serves as a resource for patients and families with regard to
their rights and responsibilites, when payment of care is denied or
when care is no longer medically necessary. Includes, but not
limited to, delivery of the regulatory documents as provided by
CMS. - 10%Minimum Qualifications
- Education - Bachelors degree in nursing, preferred
- Experience - Three (3) years acute care nursing experience. One
(1) year acute case management experience preferred. - - - -
Required Licensure - South Carolina RN licenseOther Required
Skills/Experience
- N/AWork ShiftVariable (United States of
America)LocationGreenville Memorial Med CampusFacility1008
Greenville Memorial HospitalDepartment10087517 GMH Hospital Care
MgmtShare your talent with us! Our vision is simple: to transform
healthcare for the benefits of the communities we serve. The
transformation of healthcare requires talented individuals in every
role here at Prisma Health.
Keywords: Prisma Health, Charlotte , Registered Nurse (RN)-Hospital Case Manager, PRN, Days, Executive , Greenville, North Carolina
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