RN Case Manager | Care Coordination
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.
1. Oversees the management of specific patient populations across the continuum. Serves as a resource to the multidisciplinary team for the management of complex patients.
2. 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.
3. Facilitates learning experiences of healthcare team members, conducts in-services, and/or serves as a resource for pathway development.
4. Coordinates/facilitates patient care progression throughout the continuum.
5. Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.
6. Collaborates with medical staff, nursing staff, social workers, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
7. 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.
8. 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.
9. Manages all aspects of discharge planning for assigned patients.
10. 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.
11. 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.
12. 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
0% 35% 65%
to to to
35% 65% 100% N/A Activity
X Reaching with arms
X Finger and hand dexterity
Lifting, carrying, pushing and or pulling:
X 20 lbs. maximum
X 50 lbs. maximum
X 100 lbs. maximum
To apply for this position, please click on the "Apply Now" button on this page. You must complete the application process and then submit your application by clicking on the "Submit" button located at the bottom of the page titled "Submit Online Application". You will receive the following message once you hit the submit button: "You have successfully submitted your job application".
Computers are available for applying within the lobby of the Human Resources Department located at 1920 West First Street, (on the corner of Miller and First Street) Winston-Salem, North Carolina 27104. You may also call our office for assistance at (336) 716-6464. Office hours are Monday-Friday, 8:00am-5:00pm.
If you are an individual with a disability and need reasonable accommodation to participate in the application process, please contact our Supervisor of Office Services by phone (336) 716-3367 or email at firstname.lastname@example.org.
It is the policy of Wake Forest Baptist Medical Center to administer all educational and employment activities without discrimination because of race, sex, age, religion, national origin, disability, sexual orientation, gender identity or veteran status (except where sex is a bona fide occupational qualification or a statutory requirement) in accordance with all local, state, national laws, executive orders, regulations, and guidelines.