Case Manager Nurse- Hospital

Case Manager Nurse – WVU Medicine Golisano Children’s Hospital

We are looking for a registered nurse to serve as a Case Manager at WVU Medicine Golisano Children’s Hospital. The role involves comprehensive planning for targeted patient populations, resource management, discharge planning, and coordination across multidisciplinary teams.

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state RN license through the enhanced Nurse Licensure Compact (eNLC).

• Three (3) years clinical experience.

• Bachelor’s degree in Nursing (BSN)

• 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 for designated caseload.
• Monitors the patient’s progress; intervening as necessary and appropriate, to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
• Provides education as needed to staff, physicians, and patients and their families to ensure effective transition planning.
• Meets directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team.
• Communicates with the multidisciplinary team and post-acute providers when applicable, any complex family dynamics that may directly impact patient care and transition/discharge planning.
• Initiates and facilitates 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.
• Communicates all necessary information regarding transition/discharge plan to the multidisciplinary team, patient and family.
• Provides timely and comprehensive documentation of interactions with patient and/or families and all transition/discharge planning activities and progress according to departmental policy.
• Assists patient/families with completion of medical power of attorney, health care surrogate, and advanced directives.
• Collaborates for appropriate resource and financial management which may include but is not limited to: financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination.
• Utilizes quality screens in the electronic record to identify potential issues including but not limited to avoidable delays and readmissions.
• Completes clinical reviews for patients.
• Applies approved utilization criteria to ensure medical necessity of patient’s admissions and continued stays, and documents the findings based on department standards, policy and procedure.
• Screens for appropriate authorization and level of care.
• Facilitates covered day reimbursement certification for assigned patients and discusses payer criteria and issues on a case by case basis with clinical staff (i.e., Peer to Peer) and follows up to resolve problems with payors as needed.
• Educates hospital staff and physicians to payer regulations and managed care principals to prevent denials.
• Fosters the integration of staff and/or students into the healthcare team.

• Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling are necessary body movements utilized in performing nursing duties throughout the work shift.
• Must be able to lift, move, and position patients of all weights, with varying amounts of assistance in a fair manner on a regular and recurring basis.
• Hearing within a normal range required (e.g., to assess breath sounds, heart sounds, apical pulse, monitors, etc.).
• Visual acuity must be within normal range. Must be able to perform night driving as necessary for patient care.
• Must be able to perform heavy work; exerting in excess of 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.

• Working closely with others.
• Working protracted or irregular…