Description
RN CASE MANAGER: University Hospital (Care Management)
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**Job Summary**
The RN Case Manager assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. The position is unique in that it combines clinical/quality considerations with regulatory/financial/utilization review demands.
The position creates a balance between individual clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes.
**Organizational Relationships**
The RN Case Manager reports directly to the Manager of Care Management.
The RN Case Manager works closely with the unit-based MPLAN team in reaching unit and organization goals including length of stay, care transitions, readmissions, and other quality initiatives. In the emergency departments, the RN Case Manager works collaboratively with other members of the interdisciplinary team to develop and implement a comprehensive, integrated discharge plan from the emergency department(ED). The RN Case Manager will recommend and document patient classification of all admissions utilizing established criterion set.
**Mission Statement**
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
**Responsibilities***
**Characteristic Duties and Responsibilities**
**Care Coordination and Discharge Planning**
Within 24 hours of admission interview each patient/family for anticipated needs post hospitalization
Develop plan for the day and plan for the stay with providers, patient and nursing staff
Lead daily care coordination rounds to update the plan and facilitate implementation.
Initiate discharge plan including early referrals to homecare, DME and infusion services
Prepare patient/family for discharge
In collaboration with SW partner follow standard for routine patient/family conference
Ensure patient handovers to next level of care; work closely with Care Navigators in clinics, complex care Case Managers , homecare and sub-acute liaisons
Support nursing Model of Care by working closely with nursing managers and staff to achieve Patient Family Centered Care goals: respect and dignity, information sharing, participation and collaboration
Facilitate increased volume of cases discharged by noon to improve capacity management
Collect avoidable days information; report findings in care management software, such as Allscripts
Participate in venues to reduce barriers to discharge
**Utilization Review and Utilization Management**
Conduct clinical review on admission; review every 3 days or as requested by payer
Determine patient classification with provider and ensure all patients placed in observation classification are notified; For inpatient to observation cases, ensure Condition Code 44 billing requirements are met
Communicates with third party payers to obtain necessary authorization for reimbursement of services.
Obtain anticipated LOS from provider and ensure patient and multi-disciplinary team is aware
Refer defined cases for medical secondary review and share findings with providers
Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials; input into appeals; share findings with providers
Review all cases with readmission within 30 days; report findings in Care Management software such as Allscript
Identify opportunities for cost reduction and participate in appropriate utilization management venues
Conducts referrals and consultation with Physician Advisor
**Professional Development**
Actively participates in the performance planning, competency and individual development planning process
Maintains current knowledge of case management, utilization management, and discharge planning , as specified by federal, state, and private insurance guidelines
**Expectations of the position:**
Knowledge of community resources to coordinate safe discharge from the emergency departments
Excellent interpersonal skills, as demonstrated by the ability to work effectively with individuals and or teams, across disciplines
Excellent communication and negotiation skills as demonstrated in oral and written forms
Ability to work in a collaborative partnership model with Social Workers and other members of the interdisciplinary team, both internal and external
Organizational and time management skills, as evidence by capacity to prioritize multiple tasks
**Nursing Specific Info**
Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan medicine is comprised of over 26,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.
**What Benefits can you Look Forward to?**
Nursing at Michigan offers a competitive salary with excellent benefits!
**Hourly range for Registered Nurses $38.26-$59.35 / hour**
Evening Shift Differential-$3.00 / hour
Night Shift Differential- $4.00 / hour
Day Shift Weekend Differential- $2.90 / hour
Evening Shift Weekend Differential- $5.90 / hour
Night Shift Weekend Differential- $6.90 / hour
Charge Nurse Differential- $1.00 / hour
The benefit package includes:
Excellent medical, dental and vision coverage
2:1 Match on retirement savings and immediate vesting
Generous Paid Time Off Allowances
Robust Tuition and Certification support programs
Large offering of no cost CEs and professional development for advancement
**Nursing Specific Info**
Salary & Nursing Framework Level:
This UMPNC RN posting is posted under the Role-Specific Advancement Model (RSAM) as:
RN Case Manager- COMPETENT NE
Actual RSAM LEVEL and salary will be determined at tim
Compensation Information:
$38.26 / Hourly - $38.26 / Hourly
Starting At: 38.26 Hourly
Up To: 59.35 Hourly
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