RS Case Manager, UHM Care Management
3 days left
- Full Time
The RN Case Manager assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. The position is unique in that it combines clinical/quality considerations with regulatory/financial/utilization review demands. The position creates a balance between individual clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes.Organizational RelationshipsThe RN Case Manager reports directly to the Manager of Care Management.The RN Case Manager works closely with the unit-based MPLAN team in reaching unit and organization goals including length of stay, care transitions, readmissions, and other quality initiatives. In the emergency departments, the RN Case Manager works collaboratively with other members of the interdisciplinary team to develop and implement a comprehensive, integrated discharge plan from the emergency department(ED). The RN Case Manager will recommend and document patient classification of all admissions utilizing established criterion set.
Characteristic Duties and Responsibilities Care Coordination and Discharge PlanningA.Within 24 hours of admission interview each patient/family for anticipated needs post hospitalizationB.Develop plan for the day and plan for the stay with providers, patient and nursing staffC.Lead daily care coordination rounds to update the plan and facilitate implementation.D.Initiate discharge plan including early referrals to homecare, DME and infusion services E.Prepare patient/family for discharge F. In collaboration with SW partner follow standard for routine patient/family conferenceF.Ensure patient handovers to next level of care; work closely with Care Navigators in clinics, complex care Case Managers , homecare and sub-acute liaisonsG.Support nursing Model of Care by working closely with nursing managers and staff to achieve Patient Family Centered Care goals: respect and dignity, information sharing, participation and collaborationH.Facilitate increased volume of cases discharged by noon to improve capacity managementI.Collect avoidable days information; report findings in care management software, such as AllscriptsJ.Participate in venues to reduce barriers to dischargeUtilization Review and Utilization ManagementA.Conduct clinical review on admission; review every 3 days or as requested by payerB.Determine patient classification with provider and ensure all patients placed in observation classification are notified; For inpatient to observation cases, ensure Condition Code 44 billing requirements are metC.Communicates with third party payers to obtain necessary authorization for reimbursement of services.D.Obtain anticipated LOS from provider and ensure patient and multi-disciplinary team is awareE.Refer defined cases for medical secondary review and share findings with providersF.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials; input into appeals; share findings with providersG.Review all cases with readmission within 30 days; report findings in Care Management software such as AllscriptH.Identify opportunities for cost reduction and participate in appropriate utilization management venuesI.Conducts referrals and consultation with Physician AdvisorProfessional DevelopmentA.Actively participates in the performance planning, competency and individual development planning processB.Maintains current knowledge of case management, utilization management, and discharge planning , as specified by federal, state, and private insurance guidelines
Nursing Specific Info
Required qualifications must be met by the candidate in order to be interviewed and considered for the position.Posting may be filled after the initial 5-day posting period. Applicants who have left the UMPNC bargaining unit must include on their resume dates of past employment including months and years of service along with effort. Positions less than 20 hours/week may be combined. If you have questions regarding this posting or would like assistance with nursing opportunities please contact Nurse Recruitment at (734) 936-5183.
Nursing Specific Info
Salary & Nursing Framework Level:This UMPNC RN posting is posted under the Role-Specific Advancement Model (RSAM) as: RN Case Manager- COMPETENT.
Required Educational Requirement; applicant must meet one of the following:
Bachelor’s degree in Nursing OR
Associates degree or diploma in Nursing and a Master’s degree in Nursing
A.Current State of Michigan Board of Nursing licensure
B.Minimum of 5 years of acute care nursing experience
C.A minimum of 1 year of successful experience in at least one of the following classifications: nursing management; case management; clinical care coordination; demonstrated advancement in clinical career ladder.
D.Knowledge of community resources to coordinate safe discharge from the emergency departments
E.Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, across disciplines
F.Excellent communication and negotiation skills as demonstrated in oral and written forms
G.Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external
H.Organizational and time management skills, as evidence by capacity to prioritize multiple tasksNOTE:Required qualifications must be met by the candidate in order to be interviewed and considered for the position.RESUME REQUIRED (for both internal & external applicants): You must attach a complete and accurate resume to be fully considered for this position
A.Two years hospital discharge planning experience B.Masters degree in nursing or other health related fieldC.Case Management Certification such as ACM or CCM D.Excellent analysis and data management and PC skillsE.Ability to work in autonomous and self-directed mannerF.Experience with InterQual criterion setG.Experience with AllscriptsH.Experience with quality improvement initiativesI.Two years home care or skilled home health experience
Hours: 40Shift: Day shift, 8 hour shifts with weekend and holiday commitmentsLocation: UMH Care Management- Float positions to cover University Hospital, CVC and Mott
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Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Michigan Medicine seeks to recruit and retain a diverse workforce as a reflection of our commitment to serve the diverse people of Michigan and to maintain the excellence of the University. We welcome applications from anyone who would bring additional dimensions to the University’s research, teaching, and clinical mission, including women, members of minority groups, protected veterans, and individuals with disabilities. The Department of Nursing, like the University of Michigan as a whole, is committed to a policy of nondiscrimination and equal opportunity for all persons and will not discriminate against any individual because of race, color, national origin, age, marital status, sex, sexual orientation, gender identity, gender expression, disability, religion, height, weight, or veteran status.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.