Community Case Manager, RN

ChenMed - Saint Petersburg, FL

Full-time - Mid Level

Saint Petersburg, FL

Ambulatory Health Care Services

About the position

The Case Manager at ChenMed plays a crucial role in enhancing the quality of patient management and satisfaction. This position is designed to promote continuity of care and cost-effectiveness through the integration of case management, utilization review, and discharge planning functions. The incumbent will adhere to strict departmental goals and objectives, maintain standards of performance, ensure regulatory compliance, and uphold quality patient care standards in accordance with established policies and procedures. In this role, the Case Manager will coordinate the integration of social services and case management functions into patient care, discharge, and home planning processes. This involves collaboration with other departments, external service organizations, agencies, and healthcare facilities. The Case Manager will conduct concurrent medical record reviews using specific indicators and criteria approved by the medical staff, acting as a patient advocate by investigating and reporting adverse occurrences and providing staff education related to resource utilization and discharge planning. The Case Manager will also promote effective and efficient utilization of clinical resources, mobilizing resources to achieve desired clinical outcomes within specific timeframes. They will conduct reviews for appropriate utilization of services from admission through discharge, evaluating patient satisfaction and the quality of care provided. Regular communication with physicians throughout hospitalization is essential to develop effective working relationships and assist in maintaining appropriate costs and desired patient outcomes. Additional responsibilities include coordinating the provision of social services to patients and families, completing expanded assessments of patient and family needs at the time of admission, and referring cases for counseling when necessary. The Case Manager will facilitate interdisciplinary patient care rounds and conferences to review treatment goals, optimize resource utilization, and provide family education regarding post-hospital needs. They will also direct and participate in the development and implementation of patient care policies and protocols, providing guidance in handling special cases or patient needs, and perform other duties as assigned by management.

Responsibilities

• Coordinates the integration of social services/case management functions into patient care, discharge, and home planning processes.
• Conducts concurrent medical record review using specific indicators and criteria as approved by medical staff.
• Acts as a patient advocate by investigating and reporting adverse occurrences and performing staff education related to resource utilization and discharge planning.
• Promotes effective and efficient utilization of clinical resources and mobilizes resources to assist in achieving desired clinical outcomes within specific timeframes.
• Conducts review for appropriate utilization of services from admission through discharge and evaluates patient satisfaction and quality of care provided.
• Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship.
• Assists physicians in maintaining appropriate cost, case, and desired patient outcomes.
• Coordinates the provision of social services to patients, families, and significant others to enable them to deal with the impact of illness.
• Completes expanded assessment of patients and family needs at time of admission and psychosocial assessment.
• Refers cases where patients and/or family would benefit from counseling to complete complex discharge plans to social workers.
• Facilitates interdisciplinary patient care rounds and/or conferences to review treatment goals and optimize resource utilization.
• Directs and participates in the development and implementation of patient care policies and protocols.

Requirements

• High school diploma or equivalent required.
• Bachelor's degree in a healthcare related field preferred.
• Valid, active licensure as professional nurse (RN, LPN or other nursing discipline) required.
• A minimum of 7 years' utilization review/case management experience, including psychological aspects of care.
• A minimum of 7 years' experience in discharge planning from a hospital is preferred.
• Experience in case management in a hospital and/or healthcare setting highly desired.
• Possession and maintenance of a current, valid Driver's License is required.
• Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required within the first 90 days of employment.

Nice-to-haves

• Spoken and written fluency in English.
• Strong written and verbal communication skills; presentation skills.
• Excellent organizational and time management skills.
• Astute problem-solving skills with the ability to multi-task.
• Compassionate and empathetic demeanor with the ability to work both independently and in a group/team environment.
• General computer knowledge and effective Microsoft Office Products (PowerPoint, Excel, Word and Outlook) skills.

Benefits

• Great compensation
• Comprehensive benefits
• Career development and advancement opportunities
• Work-life balance
• Opportunities to grow