Case Manager Nurse

WVU Hospitals — Ruby Memorial Hospital - Morgantown, WV

Job Title: Case Manager Nurse

Position: Care Manager

Job Type: Full Time

Pay:

Shift: Friday, Saturday, Sunday 7p-7a

Work Type: On-Site

Location

Address:

City: Morgantown

State: WV

ZIP Code:

Job Responsibilities

Comprehensively plans for targeted patient populations.
Performs resource management including denial management and utilization management.
Facilitates access to the appropriate level of care and discharge planning.
Works collaboratively with the multidisciplinary care team to achieve desired treatment outcomes.
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.
Monitors the patient’s progress and intervenes as necessary to ensure patient-focused care.
Provides education to staff, physicians, patients, and families for effective transition planning.
Assesses patient and family needs and develops individualized transition/discharge plans.
Communicates complex family dynamics that may impact patient care and transition planning.
Initiates and facilitates referrals to various post-acute services.
Communicates necessary information regarding transition/discharge plans to relevant parties.
Documents interactions and transition/discharge planning activities and progress comprehensively.
Assists patients and families with medical power of attorney and advanced directives.
Collaborates for appropriate resource and financial management.
Utilizes quality screens in electronic records to identify potential issues.
Completes clinical reviews for patients and applies approved utilization criteria.
Facilitates covered day reimbursement certification for patients and resolves payor issues as needed.
Educates hospital staff and physicians on payer regulations to prevent denials.
Fosters integration of staff and/or students into the healthcare team.

Required Skills

Core Skills

Knowledge of current medical insurance coverage and limitations.
Knowledge of relevant scientific principles and established standards of care.
Proficient in administering routine and special treatments to patients.
Knowledge and application of the nursing process.

Preferred Skills

Bachelor’s degree in Nursing (BSN)

Requirements

Experience: Three (3) years clinical experience.

Education: Current unencumbered licensure as a Registered Professional Nurse.

License & Certification:

Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)

Schedule:

Not specified

COVID-19 Requirements: Not Specified

Benefits

Not specified

Supplemental Pay

Not specified

Special Notes

Equal Opportunity Employer: West Virginia University Health System and its subsidiaries prohibit discrimination against employees, applicants, or any other covered persons.