Case Manager Nurse

WVU Hospitals — Ruby Memorial Hospital - Morgantown, WV

Job Title: Case Manager Nurse

Position:

Job Type: Full Time

Pay:

Shift: United States of America (Exempt)

Work Type:

Location

Address:

City: Morgantown

State: WV

ZIP Code:

Job Responsibilities

Manage all aspects of transition/discharge planning for assigned patients in a timely manner.
Collaborate with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload.
Monitor the patient’s progress; intervene as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
Provide education as needed to staff, physicians, patients, and their families to ensure effective transition planning.
Meet directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team.
Communicate with the multidisciplinary team and post-acute providers about any complex family dynamics that may impact patient care and transition/discharge planning.
Initiate and facilitate 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.
Communicate all necessary information regarding transition/discharge plan to the multidisciplinary team, patient, and family.
Provide timely and comprehensive documentation of interactions with patients and all transition/discharge planning activities according to departmental policy.
Assist patients/families with completion of medical power of attorney, health care surrogate, and advanced directives.
Collaborate for appropriate resource and financial management, including financial assistance coordination/referrals and entitlement program coordination/referrals.
Utilize quality screens in the electronic record to identify potential issues including avoidable delays and readmissions.
Complete clinical reviews for patients.
Apply approved utilization criteria to ensure medical necessity of patient’s admissions and continued stays, and document findings based on department standards, policy, and procedure.
Screen for appropriate authorization and level of care.
Facilitate covered day reimbursement certification for assigned patients and discuss payer criteria and issues on a case-by-case basis with clinical staff.
Educate hospital staff and physicians regarding payer regulations and managed care principles to prevent denials.
Foster the integration of staff and/or students into the healthcare team.

Required Skills

Core Skills

Knowledge of patient’s current medical insurance coverage and limitations
Knowledge of relevant scientific principles and standards of care
Knowledge of procedures and techniques involved in administering treatments
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:

Registered Professional Nurse license
Multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)

Schedule:

Scheduled Weekly Hours: 40
Working protracted or irregular hours

COVID-19 Requirements: Not Specified

Benefits

Not specified

Supplemental Pay

Not specified

Special Notes

WVUHS is an equal opportunity employer and complies with all applicable fair employment practices laws.
WVUHS prohibits discrimination against employees and applicants based on various characteristics such as race, ethnicity, gender, age, disability, and others.