RN Care Mgr UR Case Mgmt
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JOB RELATIONSHIPS
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Reports to the Director of Research and Innovation in collaboration with the CNO/VP of Patient Care
Services
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DEFINITION OF POSITION
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The Registered Nurse (RN) Care Manager will:
- Conduct a comprehensive assessment and develop thoughtful plans to implement, coordinate, monitor,
and evaluate healthcare services tailored to meet each individual’s specific needs in a cost-effective
manner.
- Perform utilization reviews to assess the appropriateness and medical necessity of healthcare services
for patients, while fostering strong relationships with payers to ensure compliance and alignment.
- Foster strong relationships with payers to ensure compliance and alignment
- Act as a patient advocate to guide patients through the complex healthcare system, ensuring their
preferences and rights are respected and helping them access appropriate care or coverage
- Facilitate coordinated patient care by collaborating with patients, their families, healthcare staff,
physicians, Advanced Practice Provider (APPs) and community services, all aimed at promoting quality
care.
- Incorporate cultural competence and awareness of Social Determinants of Health (SDOH) into assessment
and care plan development to ensure a holistic approach to patient well-being
- Take the lead on discharge planning and care coordination initiatives, with the goal of minimizing
readmissions.
- Work closely with interdisciplinary teams to create and refine patient-centered care plans.
- Regularly monitor key performance indicators (KPIs), such as length of stay and readmission rates, to
ensure optimal service delivery.
- Uphold stringent adherence to guidelines established by CMS, the Joint Commission, and all relevant
payer requirements.
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QUALIFICATIONS
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Professional
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Registered nurse with current North Carolina license (BSN preferred).
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Current BLS Healthcare Provider certification.
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Three years clinical experience in a health care facility with knowledge base of clinical nursing principles
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Case Management Certification (CCM), Accredited Case Manager (ACM) and/or Health Care Quality and Management (HCQM) certification preferred
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Knowledge of current trends and issues related to utilization and case management principles related to the hospital practice setting.
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Computer experience
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Evidence of participation in ongoing continuing education programs.
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