Summary
The Case Manager RN works in conjunction with the centralized denial prevention team, partnering with the local interdisciplinary care team to facilitate the progression of care for hospitalized patients. Together with the medical provider, the Case Manager RN collaborates with all members of the care team, focusing on efficient, high-quality care. This position ensures appropriate utilization of clinical resources with a goal of a safe and timely discharge for the patient. The role navigates health system services to support effective transitions while advising the team on healthcare industry compliance. The Case Manager RN must be adept at driving throughput metrics, clinical effectiveness, and fiscal responsibility.
Responsibilities
Initially screen all patients early in the hospitalization, particularly for patients likely to have post‑acute needs and every 1–2 days throughout their stay to facilitate care progression and establish an anticipated length of stay and transition planning needs.
Collaborate with the medical team to formulate a treatment plan that includes care transitions and promotes patient flow.
Complete an initial assessment of all admissions/observation patients to identify barriers that impact length of stay and discharge planning.
Navigates the care delivery system while collaborating with the physician and other clinical departments, ensuring that tests, treatments, consults, and procedures are appropriately indicated and performed in a timely manner.
Articulate the plan of care and communicate this plan to other care team members and patient/caregiver; intervene to maintain care progression when a deviation occurs.
Create and coordinate the overall transition plan of care based on initial assessment and concurrent collaboration with social workers, direct care providers, other hospital departments, external service organizations, agencies, healthcare facilities, community care and navigation services, and the patient and family/caregiver.
Facilitate daily Multidisciplinary Rounds (MDRs) incorporating evidence/best‑practice milestones in the plan and communicate that plan to the health care team.
Apprise the interdisciplinary team of the estimated length of stay, care progression barriers, and anticipated disposition; identify what is needed from the team to facilitate the plan.
Facilitate smooth care transitions by ensuring appropriate clinical follow‑up is arranged and referrals to proper post‑acute providers are initiated.
Communicate the plan effectively with the patient and family/caregiver, ensuring they have resources for success post‑discharge; understand organizational goals for length of stay and unplanned readmissions.
Proactively interface with the payer, where required, verifying coverage/benefits for anticipated discharge needs and obtaining authorization for post‑acute care.
Identify patients that are readmitted or at high risk for unplanned readmissions and initiate appropriate interventions; identify organizational resources within the community and engage those resources as necessary.
Document avoidable days, case management assessments, and care plans in a thorough and timely manner, per department policy.
Ensure appropriate care provider documentation supports the patient’s anticipated discharge plan of care; escalated deviations from the plan to the Physician Advisor as appropriate.
Complete clear and concise documentation of the care plan and communicate this to the interdisciplinary team and the patient/caregiver.
Identify and communicate any problems or issues affecting patient flow, patient satisfaction, safety, length of stay management, or outcomes to the department director and/or key stakeholder.
Function as a resource for governmental and health care industry regulations and ensure compliance; communicate standards to the interdisciplinary team.
Inform the patient and family/caregiver of the plan of care and the plan progression; facilitate communication with providers and encourage open dialogue.
Facilitate Care Partner Huddles/Family meetings as needed.
Attend and contribute to departmental staff meetings.
Participate and contribute to multi‑disciplinary committees and other committees or workgroups as directed.
Manage quality indicators such as avoidable delays, length of stay, resource utilization, patient satisfaction, patient flow, outlier management, and readmissions while suggesting strategies to improve organizational/departmental performance.
Assist with completion of PRIs upon request and as needed.
Maintain and model the organization’s values.
Demonstrate regular, reliable and predictable attendance.
Perform other duties as required.
Credentials
Registered Nurse (RN)
Education, Skills & Experience
NY RN License required.
Preferred: Bachelor’s degree in nursing or another healthcare‑related field.
Experience: 3–5 years in an acute care setting.
Certifications: ACM, CCM, or CMAC preferred.
BLS strongly recommended.
Working Conditions
Manual: Little or no manual skills/motor coordination and finger dexterity.
Occupational: Little or no potential for occupational risk.
Physical Effort: Sedentary/light effort. May exert up to 10 lbs.
Physical Environment: Generally pleasant working conditions.