RN Care Manager PRN

AdventHealth - La Grange, IL

Full-time - Mid Level

La Grange, IL

Hospitals

About the position

The RN Care Manager at UChicago Medicine AdventHealth plays a crucial role in ensuring patient-centered care coordination and progression through the continuum of care. This position involves collaborating with patients, families, and an interdisciplinary team to facilitate smooth transitions of care, enhance patient satisfaction, and prevent readmissions. The RN Care Manager is responsible for evaluating post-hospital needs, developing transition plans, and ensuring efficient resource utilization while adhering to regulatory compliance and departmental goals.

Responsibilities

• Ensure patient-centered care coordination and progression through the continuum of care.
• Conduct initial evaluations for transition of care needs within one calendar day of admission.
• Review necessary patient information including labs, medications, and medical records.
• Incorporate patient/family care goals and preferences into transition planning.
• Meet with patients/families to discuss discharge options and post-hospital care providers.
• Identify and collaborate with the interdisciplinary team to resolve barriers to care delivery.
• Participate in daily multidisciplinary rounds to communicate and facilitate patient care progression.
• Evaluate potential readmissions and coordinate mitigation interventions.
• Consult with Social Work for specialty services related to psychosocial needs.
• Develop discharge plans with contingency plans throughout the hospital stay.
• Escalate issues to appropriate Care Management leadership.
• Assist with End of Life conversations and advance directives.
• Facilitate patient care conferences with the multidisciplinary team as needed.
• Document anticipated dates of transition and update as necessary.
• Proactively identify patients who no longer meet medical necessity and escalate potential denials.
• Collaborate with Utilization Management staff on patient status changes.
• Ensure timely movement of patients to appropriate levels of care.
• Reassess discharge needs when a patient's condition changes.
• Ensure compliance with patient notifications and documentation requirements.
• Communicate potential out-of-pocket costs to patients/families.
• Ensure accurate discharge disposition in the EMR.
• Educate the interdisciplinary team and patients regarding payor requirements.
• Maintain clinical competency and knowledge of community resources.
• Participate in department and hospital performance improvement activities.
• Provide necessary patient care coverage and assistance with other duties as assigned.

Requirements

• Associates Degree in Nursing or RN Diploma degree.
• Registered Nurse (RN) license in the State of Illinois.
• Two years of medical/hospital nursing experience.

Nice-to-haves

• BSN or health-related Master's degree or MSN.
• Prior Care Management/Utilization Management experience.
• Knowledge of community resources and post-acute care programs.
• Knowledge of clinical and social factors affecting patient discharge status.
• Knowledge of CMS Conditions of Participation for Discharge Planning.
• Conflict management and resolution skills.
• Teamwork principles.

Benefits

• Flexible scheduling options.
• Opportunities for professional development and continuing education.
• Supportive work environment that values diversity and inclusion.