Case Manager Nurse

WVU Hospitals — Ruby Memorial Hospital - Morgantown, WV

Job Title: Case Manager Nurse

Position: Care Manager

Job Type: Full Time

Pay:

Shift:

Work Type: On-Site

Location

Address:

City: Morgantown

State: WV

ZIP Code:

Job Responsibilities

Manages all aspects of transition/discharge planning for assigned patients in a timely manner.
Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload.
Monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
Provides education as needed to staff, physicians, and patients and their families to ensure effective transition planning.
Meets directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team.
Communicates with the multidisciplinary team and post-acute providers any complex family dynamics that may directly impact patient care and transition/discharge planning.
Initiates and facilitates referrals to post-acute services, including but not limited to: Homecare, Durable Medical Equipment, Hospice Care, Long Term Acute Care Facilities, Acute Rehab Facilities, and Skilled Nursing Facilities.
Communicates all necessary information regarding transition/discharge plan to the multidisciplinary team, patient, and family.
Provides timely and comprehensive documentation of interactions with patient and/or families and all transition/discharge planning activities and progress according to departmental policy.
Assists patients/families with completion of medical power of attorney, health care surrogate, and advanced directives.
Collaborates for appropriate resource and financial management, including financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination.
Utilizes quality screens in the electronic record to identify potential issues including but not limited to avoidable delays and readmissions.
Completes clinical reviews for patients.
Applies approved utilization criteria to ensure medical necessity of patient’s admissions and continued stays, and documents findings.
Screens for appropriate authorization and level of care.
Facilitates covered day reimbursement certification for assigned patients and discusses payor criteria and issues on a case by case basis.
Educates hospital staff and physicians to payer regulations and managed care principles to prevent denials.
Fosters the integration of staff and/or students into the healthcare team.

Required Skills

Core Skills

Current unencumbered licensure with the WV Board of Registered Professional Nurses or appropriate state board
Three (3) years clinical experience
Knowledge of patient's current medical insurance coverage and limitations
Knowledge of relevant scientific principles and established standards of care
Knowledge of procedures and techniques involved in administering routine and special treatments to patients
Knowledge and appropriate application of the nursing process

Preferred Skills

Bachelor’s degree in Nursing (BSN)

Requirements

Experience: Three (3) years clinical experience

Education: Current unencumbered licensure with the WV Board of Registered Professional Nurses or appropriate state board

License & Certification:

Not specified

Schedule:

Not specified

COVID-19 Requirements: Not Specified

Benefits

Not specified

Supplemental Pay

Not specified

Special Notes

Equal Opportunity Employer: WVUHS is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws.