RN Case Manager

Job Summary 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 Relationships

The 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.

Responsibilities* Characteristic Duties and Responsibilities

Care Coordination and Discharge Planning

A.Within 24 hours of admission interview each patient/family for anticipated needs post hospitalization

B.Develop plan for the day and plan for the stay with providers, patient and nursing staff

C.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 conference

F.Ensure patient handovers to next level of care; work closely with Care Navigators in clinics, complex care Case Managers , homecare and sub-acute liaisons

G.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 collaboration

H.Facilitate increased volume of cases discharged by noon to improve capacity management

I.Collect avoidable days information; report findings in care management software, such as Allscripts

J.Participate in venues to reduce barriers to discharge

Utilization Review and Utilization Management

A.Conduct clinical review on admission; review every 3 days or as requested by payer

B.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 met

C.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 aware

E.Refer defined cases for medical secondary review and share findings with providers

F.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials; input into appeals; share findings with providers

G.Review all cases with readmission within 30 days; report findings in Care Management software such as Allscript

H.Identify opportunities for cost reduction and participate in appropriate utilization management venues

I.Conducts referrals and consultation with Physician Advisor

Professional Development

A.Actively participates in the performance planning, competency and individual development planning process

B.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 Qualifications* A.RN with BSN required

B.Current State of Michigan Board of Nursing licensure

C.Minimum of 5 years of recent acute care nursing experience

D.Three years of recent nursing management or case management experience, within the last 5 years

E.Knowledge of both patient and payor eligibility and reimbursement regulations and impact on the continuum of care

F.Knowledge of community resources to coordinate safe discharge from the emergency departments

G.Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, across disciplines

H.Excellent communication and negotiation skills as demonstrated in oral and written forms

I.Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external

J.Organizational and time management skills, as evidence by capacity to prioritize multiple tasks

NOTE:

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

Desired Qualifications* A.Two years hospital discharge planning experience

B.Masters degree in nursing or other health related field

C.Case Management Certification such as ACM or CCM

D.Excellent analysis and data management and PC skills

E.Ability to work in autonomous and self-directed manner

F.Experience with InterQual criterion set

G.Experience with Allscripts

H.Experience with quality improvement initiatives

I.Two years home care or skilled home health experience

Work Schedule Hours: 40

Shift: Day shift with weekend and holiday commitments

Location: UMH Care Management- Float positions to cover University Hospital, CVC and Mott

Background Screening University of Michigan Health System conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act.

Mission Statement The University of Michigan Health System 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.

U-M EEO/AA Statement The University of Michigan is an equal opportunity/affirmative action employer.