RN Case Manager, Care Coordination, Winston Campus "Job Details"
Winston-Salem, NC, United States
- Medical Center Blvd, Winston Salem, NC, 27157, US
07/12/2021, 11:27 AM
RN Case Manager
Winston Campus, Full time
JOB SUMMARY: Coordinates, facilitates, and/or manages patient care, using clinical nursing skills and knowledge of resource management and clinical care requirements for a designated population(s). Promotes the achievement of optimal clinical and resource outcomes and is responsible for facilitating appropriate lengths of stay and reimbursement for all hospital admissions in accordance with its goals and objectives. Acts as the key information and education resource for the interdisciplinary team. Works to develop organization-wide approaches to problem solving. Analyzes current systems and variances to identify opportunities for improvement. Works to promote quality of care through collaboration with all team members, patients and families. Plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Facilitates the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.
- Graduation from an accredited School of Nursing with a BSN and five years relevant clinical experience required.
- MSN preferred.
- Previous Case Management experience preferred.
LICENSURE, CERTIFICATION, and/or REGISTRATION:
Current license to practice as a Registered Nurse (RN) in the State of North Carolina.
- Oversees the management of specific patient populations across the continuum. Serves as a resource to the multidisciplinary team for the management of complex patients.
- Works with physician leadership and the multidisciplinary team for defined patient populations to develop clinical pathways, continuum care management programs, measurement and feedback of performance indicators for cost, quality, and service.
- Facilitates learning experiences of healthcare team members, conducts in-services, and/or serves as a resource for pathway development.
- Coordinates/facilitates patient care progression throughout the continuum.
- Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.
- Collaborates with medical staff, nursing staff, social workers, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
- Completes Utilization Management for assigned patients. Applies approved medical necessity criteria to monitor appropriateness of admissions and continued stay, and documents findings according to department standards.
- Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
- Manages all aspects of discharge planning for assigned patients.
- Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
- Coordinates with referring hospitals and internal disciplines for admission to Swing Beds and Vent rehab beds to ensure appropriate criteria is met. Understands the Swing Bed program and effectively utilizes those beds in lieu of discharge when appropriate.
- Completes and enters MDS data for Medicare patients per department process.
- Excellent oral, written, interpersonal and negotiation skills
- Demonstrates leadership skills
- Strong analytical, data management and computer skills
- Proficient with Microsoft Office Word, Excel and Outlook
- Works in a continually changing work environment
- Effective problem-solving and decision-making skills
- Effective assessment and teaching skills
- Motivation for self-direction
- Strong organizational and time management skills
- Ability to work independently and exercise sound judgment in interactions with physicians, payers, patients and families
- Ability to work collaboratively with patients, families, multidisciplinary team and community agencies to achieve desired patient outcomes
- Demonstrates knowledge of healthcare regulation and funding as it impacts to delivery of patient care
- Demonstrates knowledge of state, federal and commercial payer requirements and guidelines effecting hospital level of care eligibility, applying nationally recognized criteria to determining qualifications for hospital level of care
- Demonstrates knowledge of NC mental health system of services
- Possible exposure to infectious and contagious diseases
- Contact with patients under wide variety of circumstances
- Subject to many interruptions
- Subject to irregular hours
- Moderate noise environment
- High stress levels at times
- Continually changing work environment
Wake Forest Baptist Health and Atrium Health have joined forces in a strategic combination that will enhance care, transform medical education and create economic opportunity for countless lives in North Carolina and beyond. As a part of that combination, the two health systems will be integrating technology and platforms, including our career sites.
This means that although you are applying on the Wake Forest Baptist Health Career Site, you receive communications from the Atrium Health Recruitment Team. Please know that this is an expected process, and thanks in advance for your flexibility.
Wake Forest Baptist Health (www.WakeHealth.edu) is a nationally recognized academic health system in Winston-Salem, North Carolina, with an integrated enterprise including educational and research facilities, hospitals, clinics, diagnostic centers, and other primary and specialty care facilities serving 24 counties in northwest North Carolina and southwest Virginia.
It comprises: a regional clinical system with more than 300 locations, 2,100 physicians and 1,535 acute care beds; Wake Forest School of Medicine; and Wake Forest Innovations, which promotes the commercialization of research discoveries and operates Innovation Quarter, an urban research and business park specializing in biotechnology, materials science and information technology. Wake Forest Baptist’s clinical, research and educational programs are consistently ranked among the best in the country.
About the Team
Wake Forest Baptist Health's mission is to improve the health of our region, state and nation by:
- Generating and translating knowledge to prevent, diagnose and treat disease.
- Training leaders in health care and biomedical science.
- Serving as the premier health system in our region, with specific centers of excellence recognized as national and international care destination.
Wake Forest Baptist Health is a preeminent learning health system that promotes better health for all through collaboration, excellence and innovation.
- Demonstrate the highest standards of patient-centered care, education, research and operational effectiveness
- Responsive to the physical, emotional, spiritual and intellectual needs of all
- Cultivate selfless contribution for the greater good
- Demonstrate fairness, honesty, sincerity and accountability
- Demonstrate respect for and inclusion of all backgrounds, identities, experiences, and perspectives
- Foster mutual respect, facilitate professional growth and mentorship, and reward teamwork and collaboration
- Promote creativity to enhance discovery and the application of knowledge
- Embrace a culture of reliability through better process design and accountability
Patient and Family Promise
We promise to:
- Keep you safe.
- Care for you.
- Involve you and your family.
- Respect you and your time.