RN Case Manager Alamance Regional Medical Center
Company: Cone Health
Location: Burlington
Posted on: April 21, 2024
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Job Description:
RN Case Manager Alamance Regional Medical Center
ID
2024-22444
Location
Alamance Regional Medical Center
Work Location
US-NC-Burlington
Division : Name
System Wide
Department : Name
SW-Transitions of Care
Category
NURSING
Position Sub-Category
RN - CARE MANAGEMENT
Position Type
Full Time (40 hours/week)
Employment Type
Employee
Exempt/NonExempt
Exempt
FTE
1.00
Workforce Status
Onsite
Work Hours
40.00
Provider Schedule (specific schedule)
Monday to Friday
On call Required
No
Sub Category
RN - Care Management
Overview
Monitors patient care progress toward goals, makes recommendations
and/or utilizes appropriate resources to optimize effective,
efficient care progression and care plan goal achievement.
Coordinates care transition from inpatient to next level of care.
Performs admission and continued stay utilization reviews and
discharge screening to assure the necessity of hospital admission,
appropriate level of care, continued stay and supportive services,
appropriate safe discharge/transition plan, and to examine delays
in the provision of services. Collaborates with attending
Physicians, Mid-level Providers or Department Medical Directors
concerning status and/or medical necessity issues. When criteria is
in question, escalates care for second level Physician review when
Department Director is unavailable.Talent Pool: Nursing
Responsibilities
Performs case assessment and evaluation. Proactively conducts
initial case review within 24-48 hours of admission for all
inpatients utilizing criteria accepted by Cone Health as set form
in the department's Utilization Management Plan. Subsequent reviews
will be conducted every three days as long as the patient remains
in the hospital to comply with all State and Federal rules and
regulations. Review all patients' in observation status daily to
assess need for continued observation, discharge or conversion to
inpatient. All reviews will be documented in Midas+ and sent to
appropriate Care Management Assistant for processing to insurance
companies immediately upon completion of all inpatient reviews, and
abservcation cases as requested by the payor.
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Coordinates care planning and progression. Collaborates with
healthcare team members, including medical team to formulate
individualized plan of care and discharge plan. Initiates
implementation of discharge plan upon initial assessment and
coordinates changes to this plan with healthcare team members on an
ongoing basis. Consistently and accurately documents plan in
medical record and updates documentation as plans are revised.
Identifies patients/families with complex psychosocial needs/issues
and refers those cases to Clinical Social Work for follow up in a
timely manner.
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Ensures collaboration of healthcare team. Communicates
collaboratively on a routine basis at Care Progression meetings,
during unit/team rounds and throughout the day with the healthcare
team members to ensure patient care needs are addressed. Routinely
refers appropriate issues/cases to Department's Physician Advisor
in a timely manner. Communicates effectively with peers to assure
that patient needs are met, including hadnoffs and staff covering
care. Consistent communication with department leadership is an
expectation.
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Provides oversight of utilization of resources. Accurately
identifies issues surrounding the appropriate utilization of
resources and provides follow up corrective action in a timely
namner in collaboration with appropriate healthcare team members.
Provides immediate, on-going education of healthcare team members
on such issues as payer requirements, denials, avoidable
delays/variances, regulatory agency regulations, compliance,
post-acute provider referral processes and other appropriate
alternative care options.
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Provides documentation of case management processes. Supports other
department and healthcare team members in providing appropriate
services and effective care by supplying comprehensive
documentation in department and Cone Health electronic systems and
medical record as required by policy. Consistently and accurately
documents plan in medical record and updates documentation as plans
are revised. Provides comprehensive information to weekend staff to
assist them in providing effective follow up and continuity of
care. Routinely identifies avoidable days/variances and documents
these in the department's electronic system prior to discharge.
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Qualifications
EDUCATION:Bachelors, Nursing, required
Masters, Healthcare Related Field, preferred EXPERIENCE:- 3-5 years
of recent related acute care experience required.
- 1-2 years of Case Management and/or Utilization Review experience
preferred. LICENSURE/CERTIFICATION/REGISTRY/LISTING:REQUIRED
RN - Registered Nurse licensed in North Carolina or a Compact
state.
- Current North Carolina Registered Nurse license required.
- CPR is required for Case Managers at Behavioral Health locations
and is preferred at all other locations.
PREFERRED
- Current Case Management certification of CCM or ACM
preferred.
- CPR is required for Case Managers at Behavioral Health locations
and is preferred at all other locations.
Keywords: Cone Health, Burlington , RN Case Manager Alamance Regional Medical Center, Executive , Burlington, North Carolina
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