RN Case Manager
RN Case Manager
Posted on :
05-04-2025
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1 Vacancy
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Job Description
Description
Position at Norwalk Hospital Association
RN Case Manager
$25K SIGN ON BONUS FOR ELIGIBLE EXTERNAL CANDIDATES
Summary:
The Clinical Care Coordinator Unit is responsible for providing direction and leadership to the clinical team regarding the patient level of care and discharge transition plan. Acts as principal liaison between emergency services surgical services nursing finance physicians utilization review and medical records to ensure appropriate status is assigned. Assures patient progression of care is efficient and transition plans are executed to the appropriate level within the care continuum. Provides clinically based concurrent review of the medical record to assess and procure accurate and complete documentation of the patients diagnoses and procedures. Ensures documentation accurately reflects quality of care severity of illness and risk of mortality to support correct coding reimbursement and quality initiatives.
Responsibilities:
1. Coordinates and directs level of care appropriateness from admission and continuing throughout the entire stay. Uses discretion and independent judgment in applying appropriate initial screening criteria standards as well as maintaining compliance with
2. Prioritizes/delegates daily functions to assure completion of all required tasks. Coordinating ambulance and DME.
3. Completes planning using high risk admission data and discharge criteria. Anticipates medical /psychosocial needs in highrisk patients e.g. chronic diagnoses top ten DRGs patients frequently accessing care etc. Screens new patients daily
4. Manages level of care status throughout stay by performing continued stay reviews removing barriers to progression of care and revising transition plans as needed.
5. Ensures all appropriate regulatory documents are provided to the patient (MOON CT notice IMM HINN ABN).
6. Ensures the completion of a discharge needs assessment as well as formulation of a plan on all admissions using appropriate resources (CARL tool for bundled payment cases Navihealth etc.
7. Acts as a clinical role model to the healthcare team.
8. Leads and facilitates Multidisciplinary rounds to proactively progress the patients plan of care and discharge.
9. Addresses readmission prevention strategies and LOS concerns.
10. Queries members of the Health Care team to obtain accurate and complete documentation to ensure appropriate clinical documentation to support level of care.
11. Coordinates/collaborates to assure the implementation of all discharge plans.
12. Meets and acts on cases not meeting admission criteria and refers to physician advisors all cases requiring immediate review and / or discussion.
13. Proactively interacts with third party payers to prevent denials.
14. Acts as liaison between patient physician family and health care team regarding plan of care and progress towards goals.
15. Provides education to physicians nurses and other members of the healthcare team.
16. Provides a concise handoff to colleagues daily.
17. Tracks/trends variance data and elevates concerns/findings to management.
18. Complies with all standards and policies regarding safety / patient safety initiatives.
19. Fulfills all compliance responsibilities related to the position.
20. Performs other duties as assigned.
2. Prioritizes/delegates daily functions to assure completion of all required tasks. Coordinating ambulance and DME.
3. Completes planning using high risk admission data and discharge criteria. Anticipates medical /psychosocial needs in highrisk patients e.g. chronic diagnoses top ten DRGs patients frequently accessing care etc. Screens new patients daily
4. Manages level of care status throughout stay by performing continued stay reviews removing barriers to progression of care and revising transition plans as needed.
5. Ensures all appropriate regulatory documents are provided to the patient (MOON CT notice IMM HINN ABN).
6. Ensures the completion of a discharge needs assessment as well as formulation of a plan on all admissions using appropriate resources (CARL tool for bundled payment cases Navihealth etc.
7. Acts as a clinical role model to the healthcare team.
8. Leads and facilitates Multidisciplinary rounds to proactively progress the patients plan of care and discharge.
9. Addresses readmission prevention strategies and LOS concerns.
10. Queries members of the Health Care team to obtain accurate and complete documentation to ensure appropriate clinical documentation to support level of care.
11. Coordinates/collaborates to assure the implementation of all discharge plans.
12. Meets and acts on cases not meeting admission criteria and refers to physician advisors all cases requiring immediate review and / or discussion.
13. Proactively interacts with third party payers to prevent denials.
14. Acts as liaison between patient physician family and health care team regarding plan of care and progress towards goals.
15. Provides education to physicians nurses and other members of the healthcare team.
16. Provides a concise handoff to colleagues daily.
17. Tracks/trends variance data and elevates concerns/findings to management.
18. Complies with all standards and policies regarding safety / patient safety initiatives.
19. Fulfills all compliance responsibilities related to the position.
20. Performs other duties as assigned.
Education: ASSOCIATES LVL DGRE
Other Information:
Required: This position requires a minimum formal education of Associate Degree in Nursing and minimum of three years jobrelated experience. Registered Nurse license State of CT with minimum of one year as an acute Care Coordinator. Knowledge and expertise with use of electronic medical record and use of both Interqual and Milliman screening criteria. Excellent collaborator and team member who is able to work closely with physicians and all members of the health care team to procure the right level of care correct order for hospitalization optimal plan of care and facilitation of services. Knowledge and expertise in both CMS and insurance industry standards as well as guidelines pertaining to appropriate coverage notifications. Ability to be flexible resourceful and creative in problem solving. Excellent communication skills both oral and written. Minimum Experience: three years Desired: Certification in Case Management preferred or willing to obtain. Bachelors Degree in Nursing preferred.
Working Conditions:
Manual: Some manual skills/motor coord & finger dexterity
Occupational: Little or no potential for occupational risk
Physical Effort: Medium to Heavy effort. May exert up to 35 lbs. force
Physical Environment: Generally pleasant working conditions
Credentials: RN
Company: Norwalk Hospital Association
Org Unit: 374
Department: Care CoordinationNH
Exempt: Yes
Salary Range: $39.21 $72.83 Hourly
Credentials:
Essential:
* Registered Nurse
Education:
Essential:
* Associates Level Degree
Working conditions:
Essential:
* Some manual skills / motor coord & finger dexterity
* Little or no potential for occupational risk
* Medium to Heavy effort. May exert up to 35 lbs. force
* Generally pleasant working conditions.
EOE including disability/vets.
We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview please contact Human Resources at(for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.
Required Experience:
Manager
Employment Type
Full-Time
Key Skills
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