Rn Case Manager Discharge Planner - Hamilton, Nj

Job Overview:

In accordance with the objective and goals of the Case Management Plan and State and Federal guidelines, the RN Case Manager Discharge Planner will be responsible for all aspects of case management for an assigned group of inpatients to determine the appropriateness of the continued stay, assist in the development of the plan of care, endure that the plan is implemented in a timely manner, and identify the expected length of stay (ELOS).

The RN Case Manager works collaboratively with the inter-professional team, including physicians, social workers, clinical nurses, home care services and others as needed. This role actively participates in specific clinical initiatives focused on reducing the length of stay (LOS) and continued stay denials, improves efficiency, quality, and resource utilization.

Qualifications:

Required:

• 2+ years nursing experience. Nursing experience may include inpatient nursing, case management, utilization review, discharge planning, community health nursing.

• Bachelors in Nursing, required

Preferred:

• Utilization review, and/or discharge planning experience preferred.

• Case Management certification preferred.

Certifications and Licenses Required:

• Current licensure as a registered nurse in the State of New Jersey, BSN required

Essential Functions:

• Discharge planning and clinical review for an assigned group of inpatients to determine appropriateness utilizing standardize criteria (MCG/Interqual) to achieve the optimal outcomes and reimbursements.
• Identifies and documents variance, avoidable days, and addresses readmission reasons. Documents and escalates external/interqual barriers to discharge.
• Assists in the development of the plan of care and ensures the plan is implemented timely. Discusses with team where delays are identified; provides direction, assistance, and support in developing strategies and interventions to move patient through the continuum of care. Documents and follows up on any delays and expedites diagnostic testing, treatment, and consults. Makes referrals to Physician Advisor as needed.
• Collaborates with the Utilization Review team regarding medical necessity of inpatient admission, appropriate patient status, and duration of hospitalization.
• Collaborates with appropriate medical/nursing personnel to influence appropriate progression of care and timely, safe patient discharge.
• Participates in multi-disciplinary patient progression rounds. Focuses provider, nurse, and other health care team members on progress toward discharge including the needed tests and procedures, family education and family and patient readiness for discharge.
• In collaboration with the team, identifies barriers to a timely, safe discharge and develops a plan to address. Monitors progress of the plan. Escalated discharge barriers that team cannot address to appropriate next level.
• Works in collaboration with the patient, family and health care team to secure and coordinate services and equipment needed to manage the special health care needs of the patient post discharge.
• Ensures that the patient has a choice regarding the selection of post-acute vendors in accordance with guidelines.
• Maintains accurate documentation of all patient/family encounters and documents appropriately in the medical record and affiliated case management systems.
• Provides information and resources to patient, family and post hospital providers that will help the patient maintain his/her optimal level of health post discharge.
• Maintains knowledge of current concepts, research needs and research strategies related to case management, utilization review and discharge planning.
• Maintains knowledge of The Joint Commission, Medicare/Medicaid and other regulatory standards and requirements.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees physical, emotional, social, and financial health.

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered,

high-quality academic medicine in a compassionate and equitable manner, while delivering

a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employer