Registered Nurse (RN) - Case Manager, Full-Time, Days

Inspire health. Serve with compassion. Be the difference.\n\nJob Summary\n\nThe Hospital Case Manager (HCM) plays a crucial role in providing case management services for patients in a hospital setting. This includes ensuring efficient and cost-effective progression through the continuum of care and facilitating appropriate discharge planning. The HCM collaborates with physicians and leads a multidisciplinary team, including clinical staff and payers, to deliver high-quality, cost-effective care.\n\nEssential Functions\n

• Embrace Prisma Health's core values : Inspire health. Serve with compassion. Be the difference.\n
• Work closely with attending providers to promote effective utilization of clinical resources and enhance patient care quality and efficiency.\n
• Identify social determinants of health impacting patients and ensure interdisciplinary documentation and coordination with the ambulatory care management team.\n
• Address systems issues that may hinder diagnosis or treatment and proactively resolve any delays, advocating for the patient throughout the process.\n
• Expertly navigate value-based care, ensuring that care plans align with the patient and caregiver goals.\n
• Assess patients' psychosocial factors by evaluating their previous functioning, support systems, and coping mechanisms.\n
• Maintain an expert-level understanding of body systems and expected clinical outcomes related to various disease processes, while staying updated on regulatory changes.\n
• Ensure medical necessity and appropriate levels of care while implementing the plan of care in accordance with the Utilization Review Plan.\n
• Assist the team in navigating compliance, regulatory, and insurance requirements, regularly coordinating with third-party payors.\n
• Serve as a resource for both patients and families, clarifying their rights and responsibilities, especially regarding care payment and medical necessity.\n
• Advocate for patient and family empowerment, fostering their ability to make informed decisions and access necessary services.\n
• Perform additional responsibilities as needed.\n\nSupervisory / Management Responsibilities\n
• This is a non-management position reporting to a supervisor, manager, director, or executive.\n\nMinimum Qualifications\n
• Education : Bachelor's degree in Nursing.\n
• Experience : Minimum three years of acute care nursing experience; one year of acute care case management experience is preferred.\n\nIn Lieu Of\n
• A nursing diploma or Associate degree in Nursing may be acceptable if a BSN Memorandum of Understanding (MOU) is signed, committing to enroll in a BSN or MSN program within one year and obtain the degree within four years of hire.\n
• Employees in this title prior to 10 / 24 / 2021 are grandfathered into the title and are only required to have an AD N or Nursing Diploma.\n\nRequired Certifications, Registrations, Licenses\n
• Must have a valid Registered Nurse license in South Carolina.\n
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification is preferred.\n\nKnowledge, Skills and Abilities\n
• Knowledge of Medical Necessity Criteria is preferred.\n\nWork Shift\n\nDay (United States of America)\n\nLocation\n\n1510 Richland Hospital\n\nDepartment\n\nHospital Case Management\n\nJoin us in transforming healthcare for the benefit of our communities. We seek talented individuals to help us achieve our vision.