11807
Position Summary: While the various roles of the RN-Case Manager (RN-CM) fall under the same job code, each RN-CM works primarily in one of three functions: Bed Control, Utilization Review, or Discharge Planning. While the RN-CM may serve in one of these focused areas, the RN-CM may be asked to move to various areas of focus as deemed necessary by the needs of the department.
Qualifications Education: - Associate degree (AS) in Nursing required.
- Bachelors' degree (BS) in Nursing preferred.
Experience - Minimum of two years' current experience in nursing practice required.
- Previous experience with reimbursement and pre-certification practice preferred.
- Previous specific experience as a RN case manager in an acute care setting preferred.
Licensure/Certification/Registration - Current licensure as a Registered Nurse in the State of South Carolina in good standing (SCLLR) required.
Duties & Responsibilities: The three focus areas are as follows: - Bed Control - Participates in the coordination of care and service of a patient population across a continuum of care. The RN-CM will communicate with physicians and nurses regarding emergency and direct admissions based on bed availability, treatment plan and admission criteria; initiate and maintain communication throughout the day with Emergency Department, Operating Room, and specialty area. Attend daily care coordination rounds; strategize and recommend anticipated placement of patient to appropriate unit at appropriate time. The RN-CM will collect, analyze, evaluate and summarize data from referring hospitals, attending physicians, referring physicians and clinics regarding bed utilization; assess scheduled admissions, available beds and requested patient transfers on an on-going basis. The RN-CM will ensure compliance with standards related to pending discharges for current and following day in coordination with case managers. Collect, investigate and disseminate clinical data to other Patient Access Service personnel regarding diagnosis and treatment plans and insurance data for evaluation of admission criteria.
- Utilization Review -Participate in the coordination of care and service of a patient population across a continuum of care. Perform and coordinate the initial assessments and ongoing reassessments of the patient's status, document patient case information within a database system, and perform chart review/audits monthly or as needed. The RN-CM ensures that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the RN-CM will ensure that patients do not receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays. The RN-CM reviews precertification requests for medical necessity. Initiate elective pre-certification and coordinate urgent/emergent admission authorization; coordinate out of network admission, lack of referral from primary care provider, no insurance, and other special admissions with attending physicians and others. Refer long-term diagnoses, length of stay more than five days and other high-risk diagnoses to case management to ensure that patients remain on proper clinical pathways.
- Discharge Planning - Participate in the coordination of care and service of a patient population across a continuum of care. The RN-CM will participate in monthly case conferences by providing information pertinent to patient's needs/goals as well as partner with the Program Director in development and review of the patient's individualized coordination of care plan. The RN-CM will ensure that the patient's medical needs are addressed; consult with the patient's physicians as needed, coordinating plans of treatment, and advocating for the patient when necessary. Identify and assist patients in accessing entitlements, resources, information, and referrals for psychosocial needs. Empower patients in decision making for care planning. Maintain accurate and timely patient information, which is readily accessible for review and meet all requirements; assist in data collection for reporting/funding sources.
Conway Medical Center Where Community is Built Inside and Out
What goes on within the four walls of Conway Medical Center (CMC) for our employees is just as important to us as those we serve in the community. It s the mix of opportunities to sharpen our skills through continued growth, education, and advancement; a healthy work-life balance; and authentic leadership and support from administration that makes our patient care and reputation in the community what it is. CMC is more than just a hospital. It s the cornerstone in our community with a foundation built on trust, experience, and excellence in patient care.
Employing over 1,400 people and currently serving as one of the county s largest employers, our nonprofit medical center offers 210 inpatient beds; a 66-bed long-term care facility, Kingston Nursing Center; and a 22-bed sub-acute care facility, Medstar. The facility s medical staff is comprised of approximately 200 physicians, representing over 30 specialties.
Additionally, CMC owns Conway Physicians Group which includes the following physician practices: CPG Aynor Family Medicine; CPG Family Medicine at 11th Avenue - Aynor; CPG Carolina Bays ENT; CPG Carolina Internal Medicine; CPG Endocrinology; CPG Family Medicine at Towne Centre; CPG Family Medicine at Bell Street; CPG Family Medicine & Urgent Care at Socastee; CPG Gastroenterology; CPG Internal Medicine at Creel Street; CPG Internal Medicine at Myrtle Trace Drive; CPG Neurology; CPG Neurology at Cypress Circle; CPG OB/GYN at Carolina Forest; CPG Pediatrics at Carolina Forest; CPG Pulmonary & Sleep Medicine; CPG Waccamaw Cardiology; CPG Woman's Medical Center and CPG Conway OB/GYN.
Our diagnostic services include cardiac catheterization, PET scanning, two high-speed GE CT Systems including a 64-slice CT scanner, 3-D heart scans, PET scanning, MRI, breast MRI, bone-density screening, digital mammography, stereotactic breast biopsy, high definition endoscopy/bronchoscopy, and a sleep-disorders lab.
CMC also offers outpatient physical therapy, a cardiac rehabilitation program, and a Surgical Services Center that specializes in general and vascular surgery, joint replacement surgery, spine surgery. CMC s medical care includes critical care, telemetry, inpatient dialysis, palliative care, obstetrics, pediatrics and women's services.
If you re ready to join a true community of nursing professionals, we re ready to hear from you.