RN Case Manager
Company: Carle Health
Location: Peoria
Posted on: April 19, 2024
Job Description:
Position Summary:
The RN Case Manager integrates and coordinates the clinical care of
individuals. Facilitates the interdisciplinary plan of care in
order to meet multiple service needs, promotes continuity through
elimination of fragmentation of care/service and facilitates the
effective utilization of resources. Serves as educator and a
central source of communication for the individual and their
support systems.
Qualifications:
CERTIFICATION & LICENSURE REQUIREMENTS
Registered Professional Nurse (RN) License in state of Illinois
upon hire.
EXPERIENCE REQUIREMENTS
2 years of clinical experience in focused areas working with
multidisciplinary teams.
ADDITIONAL REQUIREMENTS
- Use of usual and customary equipment used to perform essential
functions of the position.
- Work will require travel to all 3 Carle Health hospitals.
- Required to drive your own vehicle for business purposes.
SKILLS AND KNOWLEDGE
Writes, reads, comprehends and speaks fluent English.Basic computer
knowledge using word processing, spreadsheet, email and web
browser.
Essential Functions:
- Care Coordination * Screens 100% of adult Medical Surgical
In-patient and observation patients and assesses the individual's
health status including clinical conditions, support systems and
resources to identify needs and make referrals to appropriate
multi-disciplinary services. * Prioritizes patients for care
coordination based on defined criteria.* Monitors and coordinates
an interdisciplinary plan of care in partnership with the
individual and their support services for needs and services across
the health care continuum and for transition through the levels and
locations of care. * Assumes accountability for the development and
implementation of an effective discharge plan for complex care
patients. Works with internal and external resources to co-ordinate
a timely safe transition of patient to the appropriate level of
care. * Leads and participates with the interdisciplinary team in
daily rounds, planning delivery and evaluation of patient-focused
care for prioritized patients.* Documents the case management plan
to include: clinical needs, barriers to quality care, effective
utilization of resources and pursues denials of payment and
referrals in a timely, legible manner. * Completes tighter
integration with ambulatory care management team, especially with
high risk, chronically ill patients.* Standardizes alert to cross
continuum care managers when patients are admitted* Works closely
with providers for discharge planning and determining the next
level of care * Collaborates with patients, caregivers,
internal/external healthcare providers, agencies and payers to plan
and execute a safe discharge* Collaborates with Utilization
Management team on continued stay review.
- Discharge Planning* Collaborates with patients, caregivers,
internal/external healthcare providers, agencies and payers to plan
and execute a safe discharge* Identifies and facilitate post-acute
resource needs: Home Care, Community based Referrals, Diagnostic
testing, Outpatient Therapies (Pulmonary Rehab, Cardiac Rehab,
Physical and/or Occupational Therapy), Palliative Care or Hospice.*
Ensures that the patient's degree of vulnerability has been
captured and documented on the Transitions of Care report.* Ensures
verbal communication with the ambulatory / cross continuum care
manager regarding patients who have moderate or red vulnerability
at transition. * Documents who will assume the care
coordination/management role for these patients and for what period
of time in the Common Care Plan and the Transition of Care report,
if known.* Reviews the predictive tool for readmission and document
the risk for readmission. Implement additional interventions to
mitigate the risk for readmission such as two follow-up
appointments - one at the time the predictive tool indicates the
patient is at highest risk for readmission* Utilizes the med
-to-bed program for patients with poly pharmaceuticals
- Education* Communicates patient/family learning needs that
surface to the direct care nurse. Collaborate with direct care
nurse on education plan. * Refers to content experts as appropriate
i.e. wound care team, Diabetic Educators, Respiratory Therapy or
PT.* Documents education related to medication adherence*
Facilitates patient self-management education.
- Revenue Cycle * Demonstrates a working knowledge of financial
and reimbursement processes to facilitate medical cost management,
including best practices, effective utilization of resources,
linking clinical and financial aspects of care, and access to care
and level of care. * Serves as a resource and educator to patient,
family, staff and physicians regarding financial aspects of
individual patient's resources which may affect the transition of
patients through the healthcare system. * Provides education for
the individual and family and for the team regarding benefits,
utilization of resources, levels of care, and expectations of the
transition process throughout settings across the healthcare
We are an Equal Opportunity Employer and do not discriminate
against any employee or applicant for employment because of race,
color, sex, age, national origin, religion, sexual orientation,
gender identity, status as a veteran, and basis of disability or
any other federal, state or local protected class. Carle Health
participates in E-Verify and may provide the Social Security
Administration and, if necessary, the Department of Homeland
Security with information from each new employee's Form I-9 to
confirm work authorization. - For more information:
human.resources@carle.com.
Effective September 20, 2021, the COVID 19 vaccine is required for
all new Carle Health team members. Requests for medical or
religious exemption will be permitted.
Keywords: Carle Health, Peoria , RN Case Manager, Executive , Peoria, Illinois
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