Role Overview Reports to the Director Care Management or designee. Provides coordinated care support to Physician leadership and Clinical Manager(s) of respective services. Makes daily rounds and collaborates with the clinical healthcare team across the patient care continuum to include pre-admission and post hospital discharge. Participates in the oversight of the progress of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management; Continuum of Care Management (Discharge planning) and Clinical Documentation Management. Collects data via utilization with Care Port to enhance the quality and cost effectiveness of patient care and prevent readmissions.
Responsibilities Daily rounds and collaboration with clinical healthcare team across patient care continuum including pre-admission and post hospital discharge.
Oversight of progression of specific patient population.
Functions related to Patient Advocacy, Utilization Review, Resource Management, Continuum of Care Management (Discharge planning) and Clinical Documentation Management.
Data collection via utilization with Care Port to enhance quality, cost effectiveness and prevent readmissions.
Qualifications BSN preferred and current RN license in Rhode Island or primary state of legal residency if part of NLC.
Five years of clinical experience including recent case management, patient navigation, utilization review or discharge planning.
Strong interpersonal skills and collaborative communication style.
Familiarity with InterQual™ / MCG care management criteria required.
Knowledge and skill to provide care to patients throughout life span, considering aging, development, cultural patterns.
Basic proficiency in Microsoft Office (email, Outlook calendar, keyboard).
Center Case Management (CCM)® board certification or Accredited Case Manager (ACM™) highly desirable.
Seniority level Mid-Senior level
Employment type Full-time
Job function Other