Registered Nurse - Case Manager

Job Title: RN Case Manager

Department: Clinical Resource Management

Reports To: Manager of Inpatient Case Management & System Director of Utilization and Case Management

Job Summary:

The RN Case Manager is responsible for the delivery of comprehensive nursing care to a set of assigned patients at a specific point in time. This involves the assessment of patient and care team needs and the development, implementation and evaluation of an appropriate Plan of Care, making changes in response to changing patient needs.

The RN Case Manager guides the utilization review process using recognized standards of care to assure appropriate medical necessity, level of care, patient status and related notifications are met.

The RN Case Manager guides patient progression across the care continuum to ensure safe and timely transitions to the appropriate level of care.

Job Responsibilities Include:

• Evaluates hospital admissions using evidence-based standards of care to assure care is medically necessary and delivered at the most appropriate level of care.
• Communicates effectively with providers and care teams to ensure medical necessity and patient status are appropriately captures and documented.
• Actively participates in multidisciplinary rounds as available.
• Issues federal and state notifications as indicated.
• Serves as discharge planner for patients as assigned.
• Assess patient risk for readmission, ability to self-manage and identifies community support systems as appropriate.
• Ensures patient demographics, insurance, primary care provider, and advanced directives are up to date in EMR.
• Facilitates referrals to support teams and community-based organizations.
• Works to identify and eliminate barriers to discharge.
• Works collaboratively with disciplines throughout the system to ensure optimal patient care.
• Serves as patient advocates and negotiates on behalf of the patient for needed care and services.
• Communicates payer coverage and as indicated to patients/families/decision-makers.
• Delivers required notifications in a timely fashion to allow patient/decision-makers to make informed decisions regarding the patient rights.
• Maintains working knowledge of the organizational and department objectives and goals and takes actions to achieve targeted outcomes.
• Maintains current knowledge of federal, state and accreditation standards related to UR and Discharge Planning requirements.
• Participates in system taskforces and other collaborative activities with community partners to support facility growth and transitions of care.
• Maintains high visibility and is readily approachable.
• Communicates effectively with care teams, patients, families and guests.
• Remains calm in stressful scenarios and able to resolve conflict independently, appropriately escalating concerns as indicated.
• Regularly attends team meetings. Seeks information missed where unable.
• Flexible in taking additional assignments as needed to cover for planned and unplanned events.
• Demonstrates and promotes teamwork, the ability to remain flexible and re-prioritize to cover staffing changes or gaps.
• Appropriately shares knowledge with coworkers
• Proactively participates in developing case management programs within the department and seeks out new learning experiences
• Demonstrate strong written and verbal communication skills. Enforces appropriate written and verbal communication among team members
• Exemplify satisfactory attendance and punctuality record as set forth by CHS policies.
• Exemplify a professional image in appearance, manner and presentation.
• Maintains patient confidentiality in the provision of quality care.
• Is flexible in assuming other appropriate responsibilities not noted above.

Requirements:

Education - Graduation from accredited nursing program. BSN in nursing preferred. Expected to complete Case Management Certification - or equivalent - within 18 months of hire.

Experience - Minimum 2 to 3 years' experience in an acute care hospital setting or alternate health care case management experience. Knowledge of community-based organizations and strong communication, organizational, critical thinking and problem solving skills required.

Licensure - Current unrestricted NY state RN licensure.

Physical - Ability to stand, sit or ambulate for long periods. Ability to mobilize freely around units, transport self to site locations, and perform required data entry into EMR and alternate data management systems.

• Indicates Essential functions

Cayuga Health System Commitment to Diversity, Equity & Inclusion

Cayuga Health System commits to treat all people with dignity so that everyone who comes to us is safe, cared for, and respected. We will support the growth of our employees and the health of our community by embracing the rich diversity of social and cultural identities, needs, and life circumstances of all people. We strive to recognize and overcome personal biases and systemic policies that marginalize others and contribute to disparities in healthcare access, equitable care, and good health outcomes.

Cayuga Health is dedicated to our vision for diversity, equity, and inclusion. As we strive towards our vision, we welcome the opportunity to work alongside a diverse range of employees.