Case Manager - Registered Nurse (Full Time)

POSITION SPECIFICS
Title:  Case Manager – Registered Nurse
FTE:  1.0 FTE (40 hours/week)
Schedule: Monday - Friday, 8:00AM - 4:30PM
Holiday Rotation: None
Weekend Rotation: None
On Call Requirements:  None
 
POSITION SUMMARY
The Case Manager- RN coordinates and facilitates patient care activities to promote optimum and appropriate utilization of resources, improve continuity of care across the continuum, and to contribute to patient satisfaction and outcomes. The Case Manager- RN evaluates patient health status, facilitates the proper plan for care and manages the implementation of nursing services to meet the patient’s individual health needs.  This position acts as a patient advocate, as a resource to patients/families and staff as a leader of the interdisciplinary team continuity of care/discharge planning.  This position serves as a liaison between the patient, staff and physician to establish and implement a plan of care for each patient.  
 
This individual supports the utilization management (UM) program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of government payers. This individual is responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported.
 
POSITION TECHNICAL RESPONSIBILITIES

1. Monitors adherence to the hospital's Utilization Review (UR) Plan to ensure the effective and efficient use of hospital services.
2. Performs UR functions and reviews: applies approved utilization acuity criteria to monitor appropriateness of admissions as part of the initial review (i.e. observation vs. inpatient status) and continued stays, Utilizes secondary physician reviews as appropriate.
3. Assess patients for potential needs in a timely manner and identifies those in need of case management intervention.
4. Identify patients with high risk or high cost care, coordinates interventions, and facilities appropriate discharge plans.  
5. Coordinate the integration of social services/case management functions into patient care, discharge, and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities.
6. Plan and coordinate care of the patient from pre-hospitalization through discharge.
7. Evaluate, plan, coordinate, and revise patient continuity of care/discharge plan based on patient need in collaboration with medical staff and the multidisciplinary team.
8. Continue contact with patients with chronic diagnoses to assist with life style changes as needed to prevent recurrence or exacerbation of chronic illness. 
9. Meet with patient and family to assist with disease management planning.
10. Work closely with social worker to integrate psychosocial management of patient/family needs. 
11. Mobilize resources and interviews, as needed, to achieve expected goal to assist in achieving desired clinical outcomes within the desired timeframe.  Coordinate care delivery processes and promptly intervenes in instances of delayed services or inappropriate utilization of resources.  Participate actively in interdisciplinary meetings, identifying opportunities for enhanced quality of care, barriers to discharge and communicating discharge plans. 
12. Evaluate, plan, coordinate, review, and revise patient continuity of care/discharge plan based on patient need in collaboration with medical staff and the multidisciplinary team. Participate in multidisciplinary team meetings regarding the planning and implementation of patient care; facilitate communication and problem solving related to discharge planning.
13. Coordinate and lead family conferences and/or multidisciplinary care conferences as needed.
14. Document accurate assessments and interventions in patient’s electronic medical record in an effective and timely manner.
15. Coordinate and complete MDS for SPH Swing Bed Program.

• Required:  Associate Degree in Nursing (ADN).
• Preferred:  Bachelor’s degree in nursing (BSN); Master’s Degree in nursing (MSN)

• Required: Minimum of 2 years of nursing, case management or utilization review experience
• Preferred: Two or more years of experience of case management and/or Utilization Review in a healthcare setting

• Required:  Current State of Wisconsin licensure as a Registered Nurse
• Preferred:  None

• Required:  Basic Life Support (BLS) – within 3 months of hire
• Preferred:  American Case Management Association (ACMA) Case Management certification

1. Competitive health and dental insurance options
2. Flexible paid time off to balance work and life
3. Retirement plan with immediate vesting and employer match
4. Free membership to our state-of-the-art fitness facility
5. Generous tuition reimbursement
6. Employer provided life and disability insurance
7. Free parking at facility