RN Case Manager - Inpatient - Weekdays

Employment Status

Full time

Shift

Day/Evening (United States of America)

Facility

1906 Belleview Ave SE - Roanoke CP01 Carilion Medical Center.

Requisition Number

R RN Case Manager - Inpatient - Weekdays (Open)

How You'll Help Transform Healthcare

Prim. Monday - Friday, 8am-4:30pm

Compensation Range

$76,689.60 - $115,044.80

Job Description

The RN Case Manager provides case management for assigned patient populations, utilizing clinical expertise, communication, and problem‑solving skills to achieve optimal clinical and resource outcomes. The role promotes cost‑effective care by minimizing fragmentation, maximizing coordination, and facilitating patient and family movement through the healthcare organization. Responsibilities include performing patient needs assessments upon admission and at regular intervals, facilitating referrals, supporting interdisciplinary collaboration, and ensuring regulatory compliance in discharge planning.

• Collaborates with Utilization Review Nurse.
• Maintains regular contact with assigned Utilization Review Nurse throughout the day.
• Uses InterQual software to support accurate patient statuses according to ongoing medical necessity.
• Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non‑coverage, using support staff as appropriate.
• Ensures documentation accurately reflects the patient's condition, co‑morbidities, treatment and procedures that support the most appropriate admission status and DRG assignment.
• Communicates with patients/families to ensure understanding of financial implications of discharge plans.
• Facilitates an interdisciplinary approach to patient care.
• Actively participates in Interdisciplinary Team Meetings on assigned units, sharing meaningful and professional knowledge to the team discussion regarding progression of care.
• Provides feedback to the health care team verbally and via chart entries regarding the patient's progress toward reaching expected outcomes or about barriers to the plan. Manages changes to the plan as necessary.
• Maintains effective communications with all disciplines to promote timely and appropriate discharges.
• Daily communication with Social Work and Utilization Review: includes case reviews, morning touchpoints, and ongoing throughout the workday.
• Coordinates care and services within the case managed population.
• Performs face‑to‑face assessments of patients/families when appropriate to identify individualized needs in collaboration with SW.
• Complies with CMS regulations related to discharging planning documentation.
• Coordinates referrals of post‑acute services such as home health, hospice, and durable medical equipment (DME).
• Facilitates appropriate referrals surrounding high‑cost medications for all patients, insured or uninsured, and obtains prior authorizations and/or co‑pay information.
• Ensures coordination of care when patients are transferred: acute hospital to acute hospital, and jails/prisons.
• Advocates for the patient and family throughout the entire episode of care.
• Participates in departmental and system performance improvement initiatives.
• Contributes to Carilion Clinic's performance improvement activities by engaging with predictive analytic software.
• Collects and analyzes relevant patient care and fiscal data.
• Analyzes and evaluates the effect of case management on quality outcomes and fiscal parameters.
• Complies with all departmental policies and practices and fosters teamwork and professionalism.

What We Require

Education: Registered Nurse. Bachelor's degree required. Five years of RN experience in a hospital setting may be considered in lieu of a bachelor's degree.

Experience: Three years of recent experience in a clinical health care setting with responsibilities reflecting direct management of patient care, including planning, coordination, and delivery of needed services such as education, psychosocial support, discharge planning, and utilization management. Supervisory or leadership experience is preferred.

Licensure, certification, and/or registration: Current licensure in Virginia as a Registered Nurse.

Life Support: AHA BLS‑HCP required within 6 months of hire.

Other Minimum Qualifications: Must demonstrate knowledge and competency in satisfactory orientation completion; positive interpersonal oral communication skills; effective written communication skills; integrity; innovation; team player; courteous; ability to resolve complaints/problems; customer‑focused philosophy of service delivery; willingness to work as an integral member of a multi‑skilled team; computer literacy; community and system resources; effective interpersonal relations; assertiveness; flexibility; perseverance; diplomacy and negotiation.

Benefits, Pay and Well‑being at Carilion Clinic

Carilion understands the importance of prioritizing your well‑being to help you develop and thrive. That's why we offer a well‑rounded benefits package and many perks and well‑being resources to help you live a happy, healthy life at work and when you're away.

• Comprehensive Medical, Dental, & Vision Benefits
• Employer Funded Pension Plan, vested after five years (Voluntary 403B)
• Paid Time Off (accrued from day one)
• Onsite fitness studios and discounts to our Carilion Wellness centers
• Access to our health and wellness app, Personify Health
• Discounts on childcare
• Continued education and training

Carilion Clinic is an Equal Opportunity Employer: We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age (40 or older), disability, genetic information, or veterans status.

Carilion is a Drug‑Free Workplace.

For more information on E‑Verify:

For more information or for individuals with disabilities needing special assistance with our online application process contact Carilion HR Service Center at 800‑599‑2537, 8:00 a.m. to 4:30 p.m., Monday through Friday.