Knowledge, Skills, and Abilities:

Demonstrates strong interpersonal, communication, and leadership skills. Possesses knowledge of discharge planning, utilization and case management, and care coordination across pre-acute, acute, and post-acute settings. Promotes the “right care, right time, right place” model through sound clinical judgment and independent decision-making. Maintains high emotional intelligence in a fast-paced, high-stress environment. Successfully performs all RN Case Manager responsibilities, provides staff education, supports implementation of case management and nursing models, and is recognized by peers as a departmental leader.

Responsibilities

• Oversees the management of assigned patient populations across the continuum and serves as a resource to the multidisciplinary team to ensure appropriate, safe, and timely transitions of care.
• Collaborates with departmental, physician, and nursing leadership to implement clinical pathways and address system barriers that impede diagnostic or treatment progress.
• Drives patient satisfaction and ensures all patients receive timely, appropriate, and safe discharge planning, coordinating seamless discharges and reducing excess days.
• Serves as a primary information resource for case management staff, payors, physicians, healthcare team members, and regulatory bodies, ensuring compliance with utilization review requirements, CMS Conditions of Participation, and external regulations.
• Proactively mitigates patient safety risks and discharge planning failures through the nursing process, critical thinking, and innovative approaches, seeking consultation as needed to expedite care.
• Completes utilization management, quality screening, and documentation activities accurately and timely, and ensures all discharge plan elements are communicated to patients, families, and the healthcare team.
• Identifies at-risk populations, implements interventions and reporting processes, and supports continuous improvement initiatives.
• Educates staff on case management responsibilities, accepts accountability for team outcomes, promotes staff satisfaction through team building, and collaborates with social workers using a dyad model.
• The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

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