RN Case Manager

RN Case Manager

Naples Comprehensive Health - NCH

Location : 350 7th Street North, Naples, FL, 34102

Work Type : Full Time

Work Schedule : 8 Hour Day

About NCH

NCH is an independent, locally governed non?profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.

NCH is transforming into an Advanced Community Healthcare System and were proud to : Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.

Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together.

Job Summary

The RN Case Manager serves as a patient advocate to support, guide and coordinate care for patients, families, and caregivers as they navigate their health and wellness journeys. The RN Case Manager is responsible for participating in the development of the patients plan of care and facilitating efficient throughput, ensuring appropriate utilization of resources, identifying needs, and establishing safe and appropriate discharge plans.

Essential Duties and Responsibilities

• Screen all patients for clinical, psychosocial, financial, and other factors that may affect the progression of care and collaborate with patients / families / caregivers in goal setting that is reflective of the patients needs.
• Evaluates the patients / family's / caregivers level of understanding and engagement with the progress toward goals and incorporates findings into the plan of care.
• Arranges services among community agencies, provider, patient / family / caregivers, and others involved in the plan of care.
• Provides patient / family / caregivers available tools / resources including pertinent quality measures to make informed choices.
• Develops a plan that is clinically appropriate and focused on the patients care needs and goals for care and treatment plan is consistent with patient choice and available resources.
• Facilitate bi-directional communication to enhance the handover of care from one setting and arrange / ensure all elements of the transition plan are implemented and communicated to key stakeholders including, not limited to, the health care team, patient / family / caregiver, payers, and post-acute providers.
• Identify available community resources / potential partners and advocate for resolution of gaps in the available resources and processes.
• Maintain knowledge of and ensure compliance with the federal, state, local organization and accreditation requirements that not only impact their scope of services but affect their ability to advocate for the patient.
• Ensure the patient is in the appropriate status, level of care and length of stay for the patients clinical condition and participates in multidisciplinary rounds with the care team.
• Follows through with appropriate intervention and documentation to facilitate discharge when a patient fails to meet medical necessity.
• Identify and address avoidable delay practice patterns that may require modification to support cost?effective care. Uses escalation process as needed.
• Educates patients / families / caregivers on the financial impact of their care options.
• Tracks avoidable delays / days as well as over / under utilization of resources.
• Provide the clinical information necessary for the appeals process of cases for which a denial of care or services has been received.
• Proactively prevent medical necessity denials by providing education to physicians, staff and patients, interfacing with payers and documenting relevant information.
• Participate in the development of performance improvement activities relevant to identified opportunities.
• Actively collaborates with utilization review team to facilitate and meet organizational and department goals.
• Recognizes situations that require referral to quality or risk management and makes a timely referral.

Education, Experience and Qualifications

Seniority Level

Entry level

Employment Type

Full?time

Job Function

Health Care Provider

Industries

Hospitals and Health Care

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