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.
Mission Statement
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.
Responsibilities
Characteristic Duties and Responsibilities
Care Coordination and Discharge Planning
Within 24 hours of admission interview each patient/family for anticipated needs post hospitalization
Develop plan for the day and plan for the stay with providers, patient and nursing staff
Lead daily care coordination rounds to update the plan and facilitate implementation.
Initiate discharge plan including early referrals to homecare, DME and infusion services
Prepare patient/family for discharge
In collaboration with SW partner follow standard for routine patient/family conference
Ensure patient handovers to next level of care; work closely with Care Navigators in clinics, complex care Case Managers , homecare and sub-acute liaisons
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
Facilitate increased volume of cases discharged by noon to improve capacity management
Collect avoidable days information; report findings in care management software, such as Allscripts
Participate in venues to reduce barriers to discharge
Utilization Review and Utilization Management
Conduct clinical review on admission; review every 3 days or as requested by payer
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
Communicates with third party payers to obtain necessary authorization for reimbursement of services.
Obtain anticipated LOS from provider and ensure patient and multi-disciplinary team is aware
Refer defined cases for medical secondary review and share findings with providers
Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials; input into appeals; share findings with providers
Review all cases with readmission within 30 days; report findings in Care Management software such as Allscript
Identify opportunities for cost reduction and participate in appropriate utilization management venues
Conducts referrals and consultation with Physician Advisor
Professional Development
Actively participates in the performance planning, competency and individual development planning process
Maintains current knowledge of case management, utilization management, and discharge planning , as specified by federal, state, and private insurance guidelines
Expectations of the position
Knowledge of community resources to coordinate safe discharge from the emergency departments
Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, across disciplines
Excellent communication and negotiation skills as demonstrated in oral and written forms
Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external
Organizational and time management skills, as evidence by capacity to prioritize multiple tasks
Nursing Specific Info
Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan medicine is comprised of over 26,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.
What Benefits can you Look Forward to?
Nursing at Michigan offers a competitive salary with excellent benefits!
Hourly range for Registered Nurses $41.78-$64.81/ hour
Evening Shift Differential-$3.00 / hour
Night Shift Differential- $4.00 / hour
Day Shift Weekend Differential- $2.90 / hour
Evening Shift Weekend Differential- $5.90 / hour
Night Shift Weekend Differential- $6.90 / hour
Charge Nurse Differential- $1.00 / hour
The benefit package includes:
Excellent medical, dental and vision coverage
2:1 Match on retirement savings and immediate vesting
Generous Paid Time Off Allowances
Robust Tuition and Certification support programs
Large offering of no cost CEs and professional development for advancement
Salary & Nursing Framework Level
This UMPNC RN posting is posted under the Role-Specific Advancement Model (RSAM) as: RN Case Manager- COMPETENT NE. Actual RSAM LEVEL and salary will be determined at time of hire. RSAM levels range from RN Case Manager-COMPETENT NE to RN Case Manager-EXPERT NE TO RN Case Manager-MASTERY NE to RN Case Manager- Mastery Plus NE.
If you have questions regarding this posting or would like assistance with nursing opportunities please contact Nurse Recruitment at (734) 936-5183.
Required Qualifications
Required Educational Requirement; applicant must meet one of the following: Bachelors degree in Nursing OR an Associates degree or Diploma in Nursing with a Masters degree in Nursing.
Current State of Michigan Board of Nursing licensure.
Minimum of three (3) years of acute care RN nursing experience OR 3 years care management of acute care patients.
A minimum of one (1) year of successful experience in at least one of the following classifications: nursing management (supervisor or higher); case management; demonstrated advancement in clinical career ladder (advancement from level C to level D or higher).
NOTE: In order to be considered for this position the applicant must have met or will have met all the required qualifications prior to the start date of employment.
RESUME REQUIRED (for both internal & external applicants): You must attach a complete and accurate resume to be fully considered for this position.
Desired Qualifications
Two (2) years hospital discharge planning experience
Masters degree in nursing or other health related field
Case Management Certification such as ACM or CCM
Excellent analysis and data management and PC skills
Ability to work in autonomous and self-directed manner
Experience with InterQual criterion set
Experience with Allscripts
Experience with quality improvement initiatives
Two (2) years home care or skilled home health experience
Work Schedule
Hours: 40
Shift: Day shift, 8am-4:30pm, with weekend and holiday commitments
Location: UMH Care Management
Modes of Work
Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes .
Background Screening
Michigan Medicine 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. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
U-M EEO Statement
The University of Michigan is an equal employment opportunity employer.