Case Manager, RN

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The UHealth System at the University of Miami has an exciting opportunity for a Case Manager RN in the Population Health Department.

SUMMARY

The Case Manager RN coordinates the overall interdisciplinary plan of care for patients, from admission to discharge. Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers. Evaluates the needs of the patient, the resources available, and recommends and facilitates the plan for the best outcome. Develops a discharge plan that provides the best available resources to meet ongoing patient needs and that encourages compliance with medical advice. Identifies patient care issues and suggests revisions to or new clinical pathways to improve quality of care.

CORE JOB FUNCTIONS                                                                                                          

• Identifies the patients’ risk factors or obstacles to care, and discharge and readmission risk.

• Evaluates the plan of care regularly by chart review and patient interviews, as well as collaborates with the medical team to facilitate the patients’ movement through the system

• Educates patients and families on the progression of care.

• Serves as a liaison between patients, families, and healthcare personnel to ensure necessary care is provided promptly, effectively, and in a fiscally responsible manner.

• Promotes quality care to ensure patients receive medically appropriate services in appropriate status and stay standards.

• Facilitates ongoing insurance authorization for continued stay.

• Facilitates regulatory notifications and patient signatures per policy.

• Maintains knowledge regarding insurance reimbursement policies.

• Relies on experience and judgement to plan and facilitate discharge and transition plans, and assures they meet the physical, social, and emotional needs of the patient.

• Adheres to University and unit-level policies and procedures and safeguards University assets.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS                                                                                                         

Education:

Bachelor’s Degree/ Bachelor's Degree in Nursing

Certification and Licensing:

Registered Nurse (RN)

CCM a plus

Experience:

Minimum 2 years of relevant experience 

Knowledge, Skills and Attitudes:

• Ability to communicate effectively in both oral and written form.

• Ability to recognize, analyze, and solve a variety of problems.

• Ability to analyze, organize and prioritize work under pressure while meeting deadlines.

• Ability to maintain effective interpersonal relationships.

DEPARTMENT ADDENDUM

Department Specific Functions

The qualified medical professional chosen for this role will be responsible for identifying potentially complex clients who would benefit from a patient-centered care management program to ensure medically appropriate, high quality, cost effective care.

Care managers create longitudinal, personalized care plans for patients, collaborate with and coordinate the efforts with primary care providers and clinic based care teams, facilitate referrals throughout the system, and use data analytics to prioritize efforts and improve the health of patients.

• Supports and performs duties as directed and under the supervision of RN Manager Case Management.

• Collaborates with Primary Care Providers to develop and execute longitudinal care plan as per care team agreed upon patient care plan.

• High risk patient assessment, coordination and communication to care team input from all health professionals (care managers, social workers, clinical and non-clinical teams, etc.)  and assist with following a documented