The RN Case Manager assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. The position is unique in that it combines clinical/quality considerations with regulatory/financial/utilization review demands.
The position creates a balance between individual clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes.
Organizational Relationships
The RN Case Manager reports directly to the Manager of Care Management.
The RN Case Manager works closely with the unit-based MPLAN team in reaching unit and organization goals including length of stay, care transitions, readmissions, and other quality initiatives. In the emergency departments, the RN Case Manager works collaboratively with other members of the interdisciplinary team to develop and implement a comprehensive, integrated discharge plan from the emergency department(ED). The RN Case Manager will recommend and document patient classification of all admissions utilizing established criterion set.
Characteristic Duties and Responsibilities
Care Coordination and Discharge Planning
- Within 24 hours of admission interview each patient/family for anticipated needs post hospitalization
- Develop plan for the day and plan for the stay with providers, patient and nursing staff
- Lead daily care coordination rounds to update the plan and facilitate implementation.
- Initiate discharge plan including early referrals to homecare, DME and infusion services
- Prepare patient/family for discharge
- In collaboration with SW partner follow standard for routine patient/family conference
- Ensure patient handovers to next level of care; work closely with Care Navigators in clinics, complex care Case Managers , homecare and sub-acute liaisons
- Support nursing Model of Care by working closely with nursing managers and staff to achieve Patient Family Centered Care goals: respect and dignity, information sharing, participation and collaboration
- Facilitate increased volume of cases discharged by noon to improve capacity management
- Collect avoidable days information; report findings in care management software, such as Allscripts
- Participate in venues to reduce barriers to discharge
Utilization Review and Utilization Management
- Conduct clinical review on admission; review every 3 days or as requested by payer
- Determine patient classification with provider and ensure all patients placed in observation classification are notified; For inpatient to observation cases, ensure Condition Code 44 billing requirements are met
- Communicates with third party payers to obtain necessary authorization for reimbursement of services.
- Obtain anticipated LOS from provider and ensure patient and multi-disciplinary team is aware
- Refer defined cases for medical secondary review and share findings with providers
- Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials; input into appeals; share findings with providers
- Review all cases with readmission within 30 days; report findings in Care Management software such as Allscript
- Identify opportunities for cost reduction and participate in appropriate utilization management venues
- Conducts referrals and consultation with Physician Advisor
Professional Development
- Actively participates in the performance planning, competency and individual development planning process
- Maintains current knowledge of case management, utilization management, and discharge planning , as specified by federal, state, and private insurance guidelines
Expectations of the position:
- Knowledge of community resources to coordinate safe discharge from the emergency departments
- Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, across disciplines
- Excellent communication and negotiation skills as demonstrated in oral and written forms
- Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external
- Organizational and time management skills, as evidence by capacity to prioritize multiple tasks
Required Educational Requirement; applicant must meet one of the following: Bachelors degree in Nursing OR an Associates degree or Diploma in Nursing with a Masters degree in Nursing
Current State of Michigan Board of Nursing licensure
Minimum of three (3) years of acute care RN nursing experience OR 3 years care management of acute care patients.
A minimum of one (1) year of successful experience in at least one of the following classifications: nursing management (supervisor or higher); case management; demonstrated advancement in clinical career ladder (advancement from level C to level D or higher)
NOTE: In order to be considered for this position the applicant must have met or will have met all the required qualifications prior to the start date of employment.
RESUME REQUIRED (for both internal & external applicants):
You must attach a complete and accurate resume to be fully considered for this position.
- Two (2) years hospital discharge planning experience
- Masters degree in nursing or other health related field
- Case Management Certification such as ACM or CCM
- Excellent analysis and data management and PC skills
- Ability to work in autonomous and self-directed manner
- Experience with InterQual criterion set
- Experience with Allscripts
- Experience with quality improvement initiatives
- Two (2) years home care or skilled home health experience
Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan medicine is comprised of over 26,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.
What Benefits can you Look Forward to?
Nursing at Michigan offers a competitive salary with excellent benefits!
Hourly range for RSAM Registered N
