Registered Nurse (RN) Case Manager

Thank you for considering a career at Mercy Health!

Scheduled Weekly Hours:

40

Work Shift:

Days (United States of America)

About Us 

As a faith-based and patient-focused organization, Mercy Health exists to enhance the health and well-being of all people in mind, body and spirit through exceptional patient care. Success in this goal requires a culture of compassion, collaboration, excellence and respect. Mercy Health seeks people that are committed to our values of compassion, human dignity, integrity, service and stewardship to create an environment where associates want to work and help communities thrive. 

RN Care Manager – St. Elizabeth Youngstown Hospital - Exempt Position

The RN Care Manager is responsible for providing coordination of care for patients to support safe, seamless, timely transitions across the continuum. This role utilizes a collaborative process, the RN Care Manager identifies (using quantitative and qualitative methods), assesses, plans, implements and evaluates the options and services required to meet an individual’s health and health related needs, including social- determinants that affect ones’ overall wellbeing. The RN Care Manager is responsible for screening, identification, and assessment of individuals in need of active Case Management services and promotes the right resources, at the right time and at the right place.

Essential Job Functions

• Identifies and prioritizes patients in need of care management services, using a holistic approach inclusive of biopsychosocial, functional, cultural, spiritual, and financial factors.  Plans with the patient, caregivers and members of the healthcare team to maximize health care responses, quality and cost-effective outcomes.   Monitors and revises the plan as indicated when patient condition changes.

• Completes all necessary documentation.  Maintains, clear, concise, and timely documentation in the patient record to reflect the needs of the patients.  Handovers are expected to be utilized at points of level of care change, staff change, as well as care transitions.

• Documentation will reflect plan of care to address post hospital care needs and resources and evidence of patient, family or caregiver involvement in planning.  Ensuring patient’s and caregiver’s treatment goals and preferences are incorporated into the transition of care planning and communicated to the multidisciplinary team.

• Follow standardized practices and process related to Advance Care Planning, Length of Stay management and readmission prevention.

• Supports denial prevention related to medical necessity through addressing / removing barriers to progression of care and participating in Interdisciplinary Discharge Rounds.

• Supports and promotes assertive, proactive care for patients, assisting in removing barriers related to achieving timely testing and treatment.  Ensures resources are utilized appropriately and offering alternatives to acute care to the care team.

• Works in collaboration with revenue cycle partners to help remove barriers to ensure patients are in the appropriate classification as guided by the physician.

• Works in conjunction with patient access to ensure all regulatory letters are delivered to the patient in a timely manner.

• Participates in department clinical outcome projects as well as process improvement initiatives within the care management department.

• Works collaboratively with peers to achieve facility and department goals and daily work as evidenced by appropriate and timely communication which is respectful and clear.

• Shares responsibilities, promoting team based approach to accomplish work.

• Strong collaborative partnerships with other members of the care team.

• Supports and follows compliance rules and regulation as mandated by CMS and Conditions of Participation for discharge planning and utilization management.  Addresses opportunities or potential concerns with leadership.

Stays abreast of community resources available to facilitate safe patient transitions of care and remains current on clinical advancements related to primary patient population. This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodat