RN Case Manager

Department Overview

The Care Management department provides several major services to assure safe and efficient through-put of patients during their acute hospitalization and transition to the next level of care. Our goal is to balance individual clinical and psychosocial patient/family needs with the efficient and cost-effective utilization of resources while promoting quality outcomes.RN case managers assess patients on admission for available family support, insurance resources, and potential discharge planning needs. They engage in daily multidisciplinary rounds Monday through Friday to develop and implement patient discharge plans with input from various other disciplines. The RN case manager is responsible for coordinating post-acute and discharge needs in a timely and cost-effective manner. Using established criteria to determine appropriateness of continued hospital stay, RN case managers work with payors on obtaining needed authorizations for ongoing hospitalization and/or identified post-acute needs.

Function/Duties of Position

The RN Case Manager collaborates with the patient and family, members of the multidisciplinary team, community resources and agencies, and payors to ensure the patient’s progress and level of care is appropriately determined. Intensity of service is dependent on individual patient needs as assessed by the case manager. RN case managers practice robust utilization and resource management.

The RN case manager is responsible for coordinating post-acute and discharge needs in a timely and cost-efficient manner. Using established criteria to determine appropriateness of continued hospital stay, RN case managers work with payors on obtaining needed authorizations for ongoing hospitalization and/or identified post-acute needs.

RN case managers also frequently lead multidisciplinary and family care conferences involving complex care situations. They contribute to meeting OHSU’s strategic plan of safe length of stay reduction and reduction in readmission rates.

Case Management is represented on every adult and pediatric unit and in the Emergency department. Each Case Manager has an office with a workstation near the unit they are assigned to.

Communication factors: Case Managers are available by pagers, telephone/voicemail, Microsoft Teams, Epic Secure Chat, and e-mail.

 

Specialty Case Management Roles:

ED RN Case Manager: In addition to the above basic CM functions, also provides the following:

• Using approved criteria, conducts a comprehensive patient/family assessment and admission clinical review upon admission to the emergency department to ensure appropriateness of the care setting.

• Provide early identification of high-risk patients and their needs.
• Perform care coordination and discharge planning for patients in the Emergency department and Observation units.
• Assess patients’ potential to discharge from the emergency department with community care coordination.
• Round with Advance Practice Providers at designated times BID.
• Assist the transfer center with coordinating appropriate patient transfers out of the emergency department.
• Educate providers regarding documentation requirements that support medical necessity determinations.
• Deliver Condition Code 44 notices, Observation notices, and Medicare Important

Messages.

• Document according to departmental policy.
• Leads the report to assure compliance with CMS and other insurance regulations related to
• Care Management.
• Other functions as assigned.

 

Evening Shift RN Case Manager

• Provide nurse case management support to patients, families in both the inpatient and emergency department settings for the evening shift 7 days per week.

• Receives referrals and hand out from day shift case managers.
• Complete hand out of information to day shift case managers.
• Trouble shoot and resolve any discharge delays or barriers carrying over into evening shift.
• Other functions as assigned.
• RN Case Managers are responsible to be aware of and comply with regulatory requirements of DNV, Medicaid, Medicare, and Oregon Nurse Practice Act.

 

 

Required Qualifications

• BSN Graduates: Baccalaureate Degree in Nursing from a program accredited by Commission of Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN) or Commission for Nursing Education Accreditation (CNEA) 30 days before start date.
• ADN Graduates: Associate Degree in Nursing from an accredited program 30 days before the start date.
• Associate degree Nurses required to enroll in BSN program within 3 years of hire and complete within 5 years of hire
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