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At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be.  We provide: 

• Comprehensive health benefits that start day 1
• Student Loan Repayment Assistance & Reimbursement Programs 
• Family-focused benefits  
• Wellness incentives 
• Ongoing mentorship, development, and leadership programs  
• And more 

JOB DESCRIPTION: The RN Case Manager (RN CM) is responsible for patient care coordination from admission through discharge; ensuring smooth transitions of care as the patient is discharged from the hospital setting, ensuring and facilitating high quality clinical and cost outcomes, procuring and securing post-acute services, coordinating and advocating for patients and families with both internal and external stakeholders, and identifying and addressing potential barriers to care coordination/discharge planning in an effort to foster efficient care delivery and maximize reimbursement.

The RN CM will begin the process of care coordination at the time of the patient's admission by independently completing a thorough admission assessment and/or psychosocial assessment which will allow for a timely and accurate capture of information as forecast potential barriers and begin working towards a discharge plan. The RN CM is an expert at assessing and forecasting and is able to support others with this skill.

The RN CM is an integral part of the interdisciplinary care team who is required to attend rounds, care conferences, and/or care team meetings. The RN CM will act as a representative of both the hospital care team and the patient/family in an effort to balance patient/family choice and projected care coordination needs with the ability to execute such services. The RN CM will work with the hospital care team and the patient/family in order to plan and implement the best possible plan for the patient while taking various factors, limitations, and patient/family preference into consideration. The RN CM will proactively identify and recommend post-acute services and will complete referrals to appropriate post-acute care providers in a timely manner, coordinating directly with the patient/family as well as the care team. Through continuous assessment and review, the RN CM will apply critical thinking and acquired clinical knowledge to ensure alignment and appropriateness of post ¿acute services as the patient clinically progresses throughout their stay. Ultimately, the RN CM is responsible for ensuring the discharge plan is aligned to be executed with the patient's medically cleared for discharge date as well as the projected length of stay as provided by the payor. The RN CM is able to readily identify and implement strategies to reduce unnecessary length of stay and/or resource consumption. The RN CM functions independently while assessing and formulating discharge plans and is able to successfully coordinate and navigate clinically and socially complex cases independently. The RN CM acts as a lead and resource to their team to provide support and guidance for success related to this. The RN CM is an expert in initiating and facilitating family meetings, care conferences, and crucial conversations. The RN CM has an expert knowledge base of resources as well as an advanced understanding of the post-acute care space. The RN CM escalates cases, as appropriate, to management, Physician Advisor, Complex Care team and/or Ethics committee.

It is the role of the RN CM to educate patients/families as well as the care team as it relates to post-acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices and available resources. The RN CM can anticipate and provide proactive supportive and therapeutic communication for patients, families and loved ones who are experiencing anxiety or stress due to illness, injury or physical limitations. The RN CM is the go to resource for the team when navigating complex dynamics.

The RN CM must communicate confidently, effectively, and therapeutically while being assertive and conveying an impression which reflects favorably upon the organization

The RN CM will proactively initiate and facilitate discussions with the payors in order to act as an advocate on behalf of the patient and hospital in an effort to reduce non-covered, non-authorized, or denied services. The RN CM will independently issue and administer notices of non-coverage and potential liability to patients in accordance with predetermined regulations, policies, and procedures and will support and guide their teammates through this process. The RN CM serves as an expert resource to the Physician, Interdisciplinary Care Team, and patient for the interpretation of external regulations and organizational policies and procedures as it pertains to Discharge Planning and Care Coordination. The RN CM is an expert with regulatory requirements as it relates to Government and Commercial Payors. The RN CM will ensure compliance with all third party payers and federal and state regulatory agencies and is able to guide their team mates on such requirements. The RN CM will have advanced knowledge and ensure proper use of Case Management Systems and have an in depth understanding of workflows. The UR RN will be expected to provide insight and guidance to systems and workflows. The RN CM will serve as a lead to the Case Management team.



MINIMUM QUALIFICATIONS: Must have a valid, active unencumbered Nursing license or temporary permit approved by the Georgia Licensing Board. Bachelor's degree in nursing required. 3-5 years¿ experience in Case Management (CM) required. 3-5 years healthcare experience required. Case Management certification required. CM RN Nurse II for 1 year. Must meet all quality and productivity expectations and successfully complete yearly competencies. Must meet expectations on yearly evaluation and may not have any active performance management or disciplinary action. Successful completion of yearly competencies and must obtain 12 CEU credits per year, related directly to core job functions, in addition to yearly competencies. Must actively identify and successfully lead at least one process improvement initiative and complete 4 electives such as projects, presentations, super user role related to core job functions.

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

 

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.