The RN Case Manager assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. The position is unique in that it combines clinical/quality considerations with regulatory/financial/utilization review demands. The position creates a balance between individual clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes.
Organizational Relationships The RN Case Manager reports directly to the Manager of Care Management. The RN Case Manager works closely with the unit-based MPLAN team in reaching unit and organization goals including length of stay, care transitions, readmissions, and other quality initiatives. In the emergency departments, the RN Case Manager works collaboratively with other members of the interdisciplinary team to develop and implement a comprehensive, integrated discharge plan from the emergency department(ED). The RN Case Manager will recommend and document patient classification of all admissions utilizing established criterion set.
Characteristic Duties and Responsibilities
Care Coordination and Discharge Planning A.Within 24 hours of admission interview each patient/family for anticipated needs post hospitalization B.Develop plan for the day and plan for the stay with providers, patient and nursing staff C.Lead daily care coordination rounds to update the plan and facilitate implementation. D.Initiate discharge plan including early referrals to homecare, DME and infusion services E.Prepare patient/family for discharge F. In collaboration with SW partner follow standard for routine patient/family conference F.Ensure patient handovers to next level of care; work closely with Care Navigators in clinics, complex care Case Managers , homecare and sub-acute liaisons G.Support nursing Model of Care by working closely with nursing managers and staff to achieve Patient Family Centered Care goals: respect and dignity, information sharing, participation and collaboration H.Facilitate increased volume of cases discharged by noon to improve capacity management I.Collect avoidable days information; report findings in care management software, such as Allscripts J.Participate in venues to reduce barriers to discharge
Utilization Review and Utilization Management A.Conduct clinical review on admission; review every 3 days or as requested by payer B.Determine patient classification with provider and ensure all patients placed in observation classification are notified; For inpatient to observation cases, ensure Condition Code 44 billing requirements are met C.Communicates with third party payers to obtain necessary authorization for reimbursement of services. D.Obtain anticipated LOS from provider and ensure patient and multi-disciplinary team is aware E.Refer defined cases for medical secondary review and share findings with providers F.Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials; input into appeals; share findings with providers G.Review all cases with readmission within 30 days; report findings in Care Management software such as Allscript H.Identify opportunities for cost reduction and participate in appropriate utilization management venues I.Conducts referrals and consultation with Physician Advisor
Professional Development A.Actively participates in the performance planning, competency and individual development planning process
B.Maintains current knowledge of case management, utilization management, and discharge planning , as specified by federal, state, and private insurance guidelines
A.Required Educational Requirement; applicant must meet one of the following:
Bachelor’s degree in Nursing OR
Associates degree or diploma in Nursing and a Master’s degree in Nursing
B.Current State of Michigan Board of Nursing licensure
C.Minimum of 5 years of acute care nursing experience
D.A minimum of 1 year of successful experience in at least one of the following classifications: nursing management; case management; clinical care coordination; demonstrated advancement in clinical career ladder.
E.Knowledge of community resources to coordinate safe discharge from the emergency departments
F.Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, across disciplines
G.Excellent communication and negotiation skills as demonstrated in oral and written forms
H.Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external
I.Organizational and time management skills, as evidence by capacity to prioritize multiple tasks
NOTE: Required qualifications must be met by the candidate in order to be interviewed and considered for the position.
RESUME REQUIRED (for both internal & external applicants): You must attach a complete and accurate resume to be fully considered for this position
A.Two years hospital discharge planning experience B.Masters degree in nursing or other health related field C.Case Management Certification such as ACM or CCM D.Excellent analysis and data management and PC skills E.Ability to work in autonomous and self-directed manner F.Experience with InterQual criterion set G.Experience with Allscripts H.Experience with quality improvement initiatives I.Two years home care or skilled home health experience
Salary & Nursing Framework Level: This UMPNC RN posting is posted under the Role-Specific Advancement Model (RSAM) as: RN Case Manager- COMPETENT.
Actual RSAM LEVEL and salary will be determined at time of hire.
RSAM levels range from RN Case Manager-COMPETENT to RN Case Manager-EXPERT TO RN Case Manager-MASTERY.
Hours: 40 Shift: Day shift, 8 hour shifts (0900 - 1730) with weekend and holiday commitments Location: UMH Care Management- Utilization Review Focus
MIchigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
The University of Michigan is an equal opportunity/affirmative action employer.
Internal Number: 168379
About University of Michigan - Ann Arbor
A great university is made so by its faculty and staff, and Michigan is recognized as one of the best universities to work for in the country. The Michigan culture is known for engaging faculty and staff in all facets of the university to create a workplace that is vibrant and stimulating.For two consecutive years, the Chronicle of Higher Education has placed U-M in its "Great Colleges to Work For" survey. In particular, the university earns high marks for strong relations between faculty and administrators, a collaborative system of governance, strong pay and benefits, and a healthy work/life balance.