Description
UNC Health Nash invites passionate healthcare professionals to join our team. Governed locally, we proudly serve a diverse patient base across Nash, Edgecombe, Halifax, Wilson Counties, and beyond. We are dedicated to elevating community health through excellence, compassion, and innovation, ensuring every individual receives the highest standard of care. Join us to contribute to wellness and redefine excellence in healthcare through state-of-the-art facilities and pioneering programs.
Summary
Facilitates effective and cost-efficient care of patients through case management functions such as utilization review and discharge planning. May facilitate execution of existing clinical pathways or implement new clinical pathways. May follow the patient through the continuum of care or concentrate on one aspect of case management, depending on the area assigned. In collaboration with the Interdisciplinary Patient Care Team, coordinates the discharge plan when post-discharge home care, nursing home placement, rehabilitation facilities, or community services are involved.
Responsibilities
Accesses cases to determine the most effective and cost-efficient model for care. Reviews assigned patients before admission or upon admission and selects the most appropriate care model. Recommends eligibility for pathways, protocols, or guidelines to improve patient care and resource utilization.
Performs concurrent and retrospective hospital utilization reviews for private insurance, Medicare, and Medicaid in accordance with guidelines. Communicates physician impact days and offers more cost-effective alternative approaches to minimize recurrences.
Determines frequency of patient reassessments based on identified needs and input from RN and MD. Serves as a resource for nursing staff on psychosocial, mental health, and substance abuse care. Participates in the interdisciplinary plan of care and collaborates with nursing staff on patient/family education and discharge planning.
Identifies and reports problematic DRGs, extended-stay patients, frequent readmissions, or high-risk patients. Identifies savings from early discharges and losses from extended stay or admission denials. Differentiates and reports discharge delays by origin (internal, external, patient/family).
Acts as a patient/family resource and advocate to address questions and needs in a timely manner. Coordinates and documents placement of patients into residential or rehabilitative settings, ensuring administrative requirements are completed per procedures and timelines.
Education Requirements
Graduation from an accredited college with an Associate's Degree in Nursing
Bachelor of Nursing Degree is preferred
Licensure/Certification Requirements
Current license to practice as an RN in North Carolina
Professional Experience Requirements
None to 2 years of Hospital Case Management experience
Job Details
Legal Employer: Nash Hospitals
Entity: Nash UNC Health Care
Organization Unit: NGH Case Management
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Assignment Type: Onsite
Work Schedule: Day Job
Location of Job: NASH HC
Exempt From Overtime: Exempt: No
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.