Case Manager; RN - PRN/Supplemental
Job in
Lanham, Prince George's County, Maryland, 20706, USA
Listing for:
Luminis Health Inc
Part Time, Per diem
position
Listed on 2026-01-31
Job specializations:
-
Nursing
Healthcare Nursing, Clinical Nurse Specialist
Job Description & How to Apply Below
Position: Case Manager (RN) - PRN/Supplemental
Position Objective
The Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Luminis Health to support safe, seamless, timely transitions across the continuum. Utilizing a collaborative process, the manager will identify, assess, plan, implement, and evaluate the options and services required to meet an individual’s health and health‑related needs, including social determinants that affect one’s overall wellbeing.
Promotes the right resources, at the right time and at the right level of care and is responsible for engaging and supporting patients that are in need of care management services; determines, using evidence‑based guidelines, the correct initial and ongoing level of care for patients and is able to submit appropriate denial review for Medicare, Medicaid, and commercial insurers.
Essential
Job Duties Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Identifies and prioritizes patients in need of care management services, using a holistic approach inclusive of biopsychosocial, functional, cultural, spiritual, and financial factors; uses a multidisciplinary approach to assess and plan for care needs.Identifies and implements strategies such as motivational interviewing to promote patient engagement, self‑care, treatment adherence, and optimal levels of health and well‑being.Utilizes evidence‑based guidelines (such as Inter Qual or other agreed upon evidence‑based guidelines) to promote quality care, decrease variation and mitigate waste. Verifies appropriate level of care; enters clinical review and authorized days in Epic; documents actions to avoid denied days; refers cases to Physician Advisor as appropriate.Manages observation stay patients assertively and ensures timely testing, treatment and conversion to inpatient status or discharge.Develops and coordinates transition plans for patients transitioned to home with home health, community care coordination program, Hospice or Palliative care, home infusion and routine sub‑acute and skilled post‑acute providers; completes all necessary documentation and handovers. Involves and prepares patients and families for transition from the ED, Peds, and Clatanoffor Observation unit as indicated.Maintains clear and concise documentation in each patient record to reflect physical and functional limitations, psychosocial characteristics, educational needs of patient & family, family/social support systems, financial, economic, and transition needs. Initiates referrals to disciplines as indicated.Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.Identifies potential or current patient situations which require referral to other members of the health care team such as infection control, risk management, or quality management. Assures plan of care is adjusted as appropriate and that follow‑up occurs. Keeps leadership abreast of potential issues.Utilizes all risk and predictive analytic tools such as the readmission risk tool. Applies tailored interventions to mitigate potential barriers or risk, prolonged unnecessary hospitalization and readmission prevention.Maintains compliance with all regulatory standards (CMS, commercial insurers etc).Educational/Experience Requirements
BSN or ADN with equivalent experience. BSN must be achieved within 5 years of start date in the role. Three years of experience in a clinical setting, ambulatory or post‑acute. Care coordination experience preferred.
Licensure/Certification Current licensure as a registered nurse by the Maryland Board of Nursing.
Working Conditions, Equipment, Physical Demands
There is reasonable expectation that employees in this position will be exposed to blood‑borne pathogens. Physical demands – Medium work. The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the…
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