Case Manager Registered Nurse; RN

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$37.50/hr - $56.25/hr

• Conducts complete assessments, establishes appropriate plans, and initiates interventions within desired time frames.
• Collaborates and negotiates effectively with patient, family, and team while striving to achieve patient and organizational goals with regard to patient’s care needs, choice and satisfaction when discharge planning/transitioning care.
• Utilizes patient/family strengths in the problem‑solving process, involving the patient/family and team in decision‑making from admission through hospital stay.
• Provides continuity of care and discharge planning services compliant with regulatory standards, coordinating relevant options and services based on assessed needs.
• Provides case management services related to various levels of health care, finances, housing, family discord, or illness adjustment, as per department scope.
• Manages family dynamics and crisis situations in a timely professional manner, using community resources and educating patient/family regarding access to services.
• Initiates internal and external referrals to assure timely progression of care and transitions.
• Documents discharge planning interventions and utilization review activity per department and medical center standards.
• Performs and documents accurate concurrent and retrospective reviews based on approved established criteria.
• Communicates effectively with the healthcare team and works in partnership with Social Work and unlicensed support personnel to implement a safe plan of care.
• Serves as an active member of the Outcome Facilitation Team/Patient Care Multidisciplinary Team, working closely with medical staff, hospital departments, and ancillary services to identify and resolve barriers to discharge.
• Collaborates with managers, physicians, medical directors, advisory groups, and treatment teams on issues related to physician practices and best practices for the patient’s plan of care.
• Refers cases to physician advisor as needed to ensure efficient progression of care and compliance with regulatory guidelines.
• Remains knowledgeable in healthcare regulations, reimbursement issues, and community resources.
• Completes UM activities as required, including providing clinical updates to payers, coordinating denial activity, supporting UM activity, and managing avoidable delays.
• Delivers CMS regulatory notices within established time frames.
• Develops and maintains productive relationships with community‑based agencies and networks.
• Works in collaboration with Advocate Aurora Ambulatory Care Management and Continuing Health to meet common goals and outcomes.
• Serves as an educator and expert resource to medical and hospital staff regarding admission status, utilization management, care coordination, and regulatory requirements.

• Registered Nurse License issued by the state in which the Team Member practices.

• Bachelor’s Degree in Nursing.
• 2 years of clinical nursing experience.

• Ability to prioritize and organize work.
• Effective communication skills.
• Utilization of critical thinking and timely decision making.
• Ability to navigate the Electronic Health Record.
• Basic utilization of MS Office products.
• Knowledge of Medicare A and B guidelines.
• Knowledge of Managed Care program requirements/implications.
• Ability to apply elements of Utilization Management programs.

• Must be able to sit up to approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
• Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally.
• Manual dexterity required for operation of computer and calculator.
• Visual acuity required for facilitating review of written documents/computer screens, medical records, and to record information accurately.
• Clear verbal communications and hearing acuity required for receiving instructions and conversing on standard telephone.
• Functional speech and hearing to allow effective communication of instructions and conversation over the telephone.
• Exposed to normal office environment; including usual hazards related to operating electrical equipment.
• Operates all equipment necessary to perform the job.

• Not Applicable

• Full‑time

• Other

• Hospitals and Health Care

Milwaukee, WI $65,000.00-$85,000.00 1 month ago