RN Inpatient Case Manager

$87,318 - $157,289/Yr

MedStar Health - Clinton, MD

Full-time - Mid Level

Clinton, MD

Hospitals

About the position

The position involves reviewing and facilitating the Continuum of Care to achieve desired clinical outcomes through collaboration with patients, families, physicians, and healthcare providers. The role focuses on integrated patient care quality monitoring, utilization review, and discharge planning, ensuring compliance with regulations and standards while providing support to patients and their families.

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 in achieving compliance with the Joint Commission manual.
• 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 particular payor requirements.
• Advise physicians on commercial insurer requirements.
• Complete clinical reviews for appeals and Medicaid Administrative Days upon request.
• 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 in a timely manner.
• 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 patients needing long-term placement and coordinate with healthcare providers.
• Document assessments, discharge plans, and outcomes in the medical record.
• Coordinate multidisciplinary clinical management conferences.
• Assist patients in assessing discharge options and determining a plan for continuing care.
• Provide clinical social services to meet patient needs and make referrals to Pastoral Care and community groups.
• Comply with State law for reporting abuse/neglect for children and adults.
• Complete psychosocial history and assessment for high-risk patients.
• Identify high-risk patients and make prompt referrals to social services.
• Communicate effectively and maintain confidentiality in accordance with hospital policy.
• Participate in organizational improvement and policy formulation related to case management processes.
• Attend required departmental staff meetings and participate in educational programs.

Requirements

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

Benefits

• Collaborative, inclusive, diverse, and supportive work environment.
• Career mentoring to help pursue passions and gain skills.
• Competitive salary and Total Rewards benefits for wellbeing.
• Regional & National recognition, advanced technology, and leading medical innovations.