RN Case Manager

POSITION SUMMARY

Incumbent serves as an Outpatient/Inpatient Nurse Case Manager as the supportive contact for specified groups of identified high risk patients; will specifically focus on specialty clinics that need specific Case Management attention. The case manager meets essential health and social needs for patients while ensuring quality cost effective healthcare. The case manager facilitates care transitions from admission through discharge ensuring continuity of care alignment of services and post hospital referrals to continuing care agencies. Also serves as a resource for nursing physicians and ancillary departments on transitional and regulatory issues. The case manager will experience working with culturally diverse patient populations having multiple barriers to self-sufficiency such as: illiteracy welfare dependency domestic violence substance abuse and mental health issues. The Nurse Case Manager will be responsible for assessment service planning resource acquisition monitoring progress and initiating the responding to emerging client needs.

Collaborates with an interdisciplinary team to assess care plans monitor progress and make recommendations to ensure safe and efficient hospitalizations. Responsible for evaluating patients in the ED for medical necessity and care coordination needs. Assesses potential admissions and works with advanced practice clinicians/physicians to determine appropriate admission status. Proposes and implements outpatient plans for safe discharge from the ED with physician approval. Coordinates care for patients with abuse chronic pain and frequent utilization issues. Interacts with patients or customers of all ages from newborn to geriatric.

As part of this role they will also interact with individuals who have mental health issues to help them access and navigate the resources they need to improve their well-being. with individuals who have mental health issues to help them access and navigate the resources they need to improve their well-being.

NECESSARY QUALIFICATIONS

Education:

Associates or Bachelors Degree in Nursing

Certifications/License:

A valid current full and unrestricted Professional Nursing License to practice nursing in any state of the United States of America The Commonwealth of Puerto Rico or a territory of the United States

Must have and maintain current Basic Life Support (BLS) certification by the American Heart Association throughout employment

Experience:

Three (3) years of clinical nursing experience with (1) year in an Outpatient/Inpatient setting

Demonstrated knowledge of the case management contract health and utilization review processes

Shift: Monday to Friday 8am-5pm & Weekend rotation with call