RN Case Manager - Medical Pod

RN Case Manager – Medical Pod

Position Overview

The RN Case Manager provides case management for assigned patient populations. Utilizes clinical expertise, communication, and problem‑solving skills to achieve optimal clinical and resource outcomes. Promotes cost‑effective care by minimizing fragmentation, maximizing coordination, and facilitating patient/family movement through the health care organization. Performs patient needs assessments upon admission and at regular intervals, facilitating referrals and providing linkages to health, wellness, and post‑acute care resources across the health care continuum. Promotes interdisciplinary collaboration and teamwork to progress the plan of care and discharge plan. Promotes appropriate length of stay, resource management, and care transitions to the next level of care. Must comply with all federal and state regulations surrounding the discharge process. Must possess knowledge of growth and development appropriate to the age group served and incorporate a plan to meet needs into the plan of care.

Responsibilities

• 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 or 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 regarding progression of care.
• Provides feedback to the health care team verbally and via chart entries regarding the patient's progress toward expected outcomes or about barriers to the plan and manages changes as necessary.
• Maintains effective communication with all disciplines to promote timely and appropriate discharges.
• Communicates daily 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 Social Work; reviews assigned census daily with SW partner to determine patient statuses and needs.
• Completes documentation in the medical record in a timely manner, accurately reflecting the plan of care and interventions; complies with CMS regulations related to discharge planning documentation.
• Coordinates referrals of post‑acute services such as home health, hospice, and durable medical equipment; directs liaison activities to appropriately integrate the patient into the health care continuum.
• Facilitates appropriate referrals surrounding high‑cost medications for all patients, insured or uninsured; works with other disciplines and support staff to obtain prior authorizations and/or co‑pay information to ensure medication needs are met for discharge and do not create barriers.
• Ensures coordination of care when patients are transferred: acute hospital to acute hospital, and jails/prisons; communicates with outside nursing or case management staff as appropriate for a smooth transition.
• 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.
• Participates in unit‑based IDR morning and afternoon huddles.
• Coordinates referrals for DME, home health, and hospice.
• Utilizes predictive analytic software (example: JVION).
• Completes face‑to‑face patient assessments.
• Communicates with assigned UR nurse and SW partner.
• Reassesses patients and documents status of referrals, movement on barriers.
• Integrates InterQual information during unit huddles and throughout the workday as appropriate.
• Provides medication assistance to patients identified in need (RX Help, CMAP); initiates medication investigations.
• Communicates post‑acute care needs of inmates during transitions back to jail.
• Assists in acute‑acute and transitions of care.
• Maintains awareness and anticipates unit‑based patient needs.
• Provides hand‑off communication of unit needs to peers during weekday/weekend transitions.

Qualifications Overview

• Education: Registered Nurse. Bachelor's degree required; up to 5 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: planning, coordination, and delivery of needed services such as education, psychosocial support, discharge planning, and utilization management. Supervisory or leadership experience is preferred.
• Licensure and Certification: Current licensure in Virginia as a Registered Nurse; AHA BLS‑HCP required within 6 months of hire.
• Technical and Soft Skills: Computer literacy, knowledge of community and system resources, effective interpersonal relations, assertiveness, flexibility, perseverance, diplomacy, negotiation, integrity, innovation, team player, courteous, customer‑focused philosophy, and problem‑solving ability.
• Other Minimum Qualifications: Must demonstrate knowledge and competency in orientation completion, positive interpersonal oral communication, effective written communication, and willingness to work as a member of a multi‑skilled team.

Compensation Range

$76,689.60 - $115,044.80

Benefits

• 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 Carilion Wellness centers
• Access to health and wellness app, Personify Health
• Discounts on childcare
• Continued education and training

Equal Employment Opportunity

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.

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