RN Inpatient Case Manager

MedStar Health - Clinton, MD

Full-time - Mid Level

Clinton, MD

1,001-5,000 employees

Hospitals

About the position

The RN Inpatient Case Manager is responsible for reviewing and facilitating the Continuum of Care to achieve desired clinical outcomes. This role involves collaboration with patients, family members, physicians, and healthcare providers to ensure quality patient care and compliance with regulatory standards. The position requires integrated patient care quality monitoring, utilization review, and discharge planning coordination, ensuring that patients receive appropriate care throughout their hospital stay and beyond.

Responsibilities

• Perform integrated patient care quality monitoring using approved comprehensive monitors.
• Immediately notify the Quality and Accreditation Improvement Department of urgent/critical quality issues.
• Identify cases for potential peer review and report these cases to the Quality and Accreditation Department.
• Document all screening and outcome variations according to Quality & Accreditation Department process.
• Assist MSMHC in achieving compliance with Joint Commission standards.
• Perform utilization review in accordance with the Utilization Management Plan and State of Maryland Regulations.
• Maintain current clinical records and prepare monthly statistical reports.
• Be available on a rotating basis on weekends, evenings, and holidays for onsite services.
• Perform the denial process for all patients according to payor requirements.
• Advise physicians on commercial insurer requirements.
• Complete clinical reviews for appeals and Medicaid Administrative Days.
• Distinguish between acute, intermediate, and skilled levels of care.
• Contact managed care companies daily to assure reimbursement for continued stay.
• Refer concurrent utilization problems to the Physician Advisor for review.
• Complete admission and continued stay criteria reviews for certification and approval.
• Facilitate the Continuum of Care through coordination of the discharge planning process.
• Assess patient discharge planning needs and consult with physicians for post-discharge treatment plans.
• Counsel patients regarding financial assistance and make appropriate referrals.
• Assess level of care for long-term placement and coordinate with healthcare providers.
• Document assessments, discharge plans, and outcomes in the medical record.
• Coordinate multidisciplinary clinical management conferences.
• Serve as a patient advocate and communicate effectively with all stakeholders.
• Participate in organizational improvement and policy formulation related to case management.

Requirements

• ADN, BSN, MSN, or CNL from an accredited School of Nursing required.
• Active MD RN License or Active Compact State RN required.
• Basic Life Support for Healthcare providers certification required.
• 1-2 years of experience required, 3-4 years preferred.

Nice-to-haves

• Experience in patient monitoring.

Benefits

• Competitive salary
• Total Rewards benefits
• Career mentoring for professional growth
• Collaborative and inclusive work environment
• Access to advanced technology and medical innovations