Care Manager II (RN): HOI-Care Management

Primary Duties and Responsibilities

The Care Manager (RN/MSW) utilizes clinical expertise, patient assessments, and insurance payer requirements to coordinate patients’ needs through the continuum of care including post-acute care and discharge plans. This role works in collaboration with the physicians, nurses, clinical staff, and community agencies to identify and arrange for appropriate care. Resource utilization is considered when coordinating the patients’ needs through the continuum of care. May focus more heavily on a specific aspect of Care Management like discharge planning, utilization review, and/or providing psychosocial support. May review clinician assessments and patients’ financial, family and psychosocial support to develop comprehensive discharge plans. May review records to assess for appropriate admission status, level of care, payer source, and UR contracts to validate billing. May provide psychodynamic intervention and crisis counseling to support patients and families. May educate patients and families on their healthcare options and connect them with resources. Documents pertinent patient issues, contacts and discharge plans on the medical records. Is a mandated reporter for elder, child, and spousal abuse. Performs other duties as assigned.

In additional to the above, the Care Manager II (RN) trains and mentors new staff. If in a Magnet facility, participates in Magnet councils and act as a preceptor in the Nurse Care Manager intern program.

Education and Experience

Five years’ of clinical or Social Work experience in an acute healthcare system environment. Bilingual or multilingual preferred.

Fulfills mandatory stroke education requirements per certification agency

Additional positions requirements depend on licensure and are as follows:

• Care Manager II (RN) – Bachelor’s or Master’s degree in Nursing (BSN/MSN). One year of experience in discharge planning or utilization review required. Experience in Interqual or Millennium Guidelines required. Experience with healthcare database systems.

License Required

• Registered Nurse (RN) license - for Care Manager II (RN) position

License Preferred

N/A

Certifications Required

N/A

Certifications Preferred

• Utilization Review
• Care Management
• Clinical Nursing