Provides case management for assigned patient populations. Utilizes clinical expertise, communication and problem solving skills to achieve optimal clinical and resource outcomes. Promotes cost-effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization. Performs patient needs assessments upon admission and at regular intervals; facilitating referrals and providing linkages to health, wellness, and post-acute care resources across the health care continuum. Promotes interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan. Promotes appropriate length of stay, resource management, and care transitions to the next level of care. Must comply with all federal and state regulations surrounding the discharge process. Must possess knowledge of growth and development appropriate to age group served and incorporate plan to meet needs into plan of care.
- Collaborates with Utilization Review Nurse.
- Facilitates an interdisciplinary approach to patient care.
- Coordinates care and services within the case managed population.
- Performs face-to-face assessments of patients/families when appropriate to identify individualized needs in collaboration with SW. CM will review assigned census beginning each day with their SW partner to determine patient statuses and needs for the day.
- Documentation in the medical record is completed in the appropriate time frame, accurately reflecting the plan of care and CM interventions. Complies with CMS regulations related to discharging planning documentation.
- Facilitates appropriate referrals surrounding high-cost medications for all patients, insured or uninsured. Works with other disciplines along with support staff to obtain prior authorizations and/or co-pay information to ensure medication needs are met for discharge and do not create a barrier.
- Ensures coordination of care when patients are transferred: acute hospital to acute hospital, and jails/prisons. Communicates with outside nursing or case management staff as appropriate for smooth transition.
- Advocates for the patient and family throughout the entire episode of care.
- Participates in departmental and system performance improvement Initiatives.
- Participate in Unit-based IDR morning and afternoon huddles.
- Coordinate referrals for DME, HH, Hospice.
- Utilize predictive analytic software (example: JVION).
- Communicate with assigned UR nurse and SW partner.
- Reassess patients and document status of referrals, movement on barriers.
- Aids in the delivery of regulatory letters (IM, HINN, etc).
- Integrates InterQual information during unit huddles and throughout workday as appropriate.
- Provides Medication Assistance to patients identified in need (RX Help, CMAP).
- Initiates Medication Investigations (need for authorization, obtain co-pay information).
- Communicate post-acute care needs of inmates during transitions back to jail.
- Assist in acute-acute and transitions of care.
- Maintain awareness and anticipate unit-based patient needs.
- Provide hand-off communication of unit needs to peers during weekday/weekend transition.
Education: Registered Nurse. Bachelor's degree required. 5 years of Case Management experience in a hospital setting may be considered in lieu of a Bachelor's Degree.
Experience: Three years of recent experience in a clinical health care setting with responsibilities reflecting direct management of patient care including planning, coordination, and delivery of needed services such as education, psychosocial support, discharge planning and utilization management. Supervisory or leadership experience is preferred.
Licensure, certification, and/or registration: Current licensure in Virginia as a Registered Nurse.
Other Minimum Qualifications: Must demonstrate knowledge and competency in the following areas: satisfactory completion of orientation; positive interpersonal oral communication skills; effective written communication skills; integrity; innovation; team player; courteous; ability to resolve complaints/problems; customer-focused philosophy of service delivery; ability; willingness to work as an integral member of a multi-skilled team. Also demonstrate knowledge and competency in; computer literacy; community and system resources; effective interpersonal relations; assertiveness; flexibility; perseverance; diplomacy and negotiation.
This is Carilion Clinic ...
An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.
Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.
Requisition Number: 137823
Employment Status: Full time
Location: CRMH - Carilion Roanoke Memorial Hospital
Shift Details: Monday - Friday; 8a-4:30, periodic on call requirements
Recruiter: DANA E JOHNSON
Recruiter Phone: 540-400-4631
Recruiter Email: email@example.com
For more information, contact the HR Service Center at 1-800-599-2537.
Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity
Carilion Clinic is a drug-free workplace.