Case Manager (RN) - Weekend Only - 8 hours

Position Objective: The Case Manager works under the direction of the clinical director of care management, providing coordination of care for patients at Luminis Health to support safe, seamless, and timely transitions across the continuum. Utilizing a collaborative process, the case manager will identify (using quantitative and qualitative methods), assess, plan, implement, and evaluate the options and services required to meet an individual’s health and health-related needs, including social determinants that affect overall wellbeing. The case manager promotes the right resources, at the right time, and at the right level of care. They are responsible for engaging and supporting patients in need of care management services, determining the appropriate level of care using evidence-based guidelines, and submitting appropriate denial reviews for Medicare, Medicaid, and commercial insurers. Essential Job Duties: Identifies and prioritizes patients in need of care management services using a holistic approach that includes biopsychosocial, functional, cultural, spiritual, and financial factors; employs a multidisciplinary approach to assess and plan for care needs. Implements strategies such as motivational interviewing to promote patient engagement, self-care, treatment adherence, and optimal health and wellbeing. Uses evidence-based guidelines (e.g., InterQual) to promote quality care, reduce variation, and mitigate waste. Verifies appropriate level of care, enters clinical review and authorized days into Epic, documents actions to prevent denied days, and refers cases to Physician Advisor as needed. Manages observation stay patients assertively, ensuring timely testing, treatment, and appropriate conversion to inpatient status or discharge. Develops and coordinates transition plans for patients moving to home with home health, community care, hospice, palliative care, home infusion, or post-acute providers; completes documentation and handovers, and involves patients and families in transition planning. Maintains clear documentation in patient records reflecting physical and functional limitations, psychosocial characteristics, educational needs, family/social support systems, financial and economic factors, and transition needs. Initiates referrals as indicated. Participates in clinical outcome projects and process improvement initiatives within care management. Identifies situations requiring referral to other healthcare team members, such as infection control, risk management, or quality management, and ensures follow-up and plan adjustments. Utilizes risk and predictive analytics tools (e.g., readmission risk tool) to apply tailored interventions that mitigate barriers, prevent unnecessary hospitalization, and reduce readmissions. Ensures compliance with all regulatory standards (CMS, commercial insurers, etc.). Educational/Experience Requirements: BSN or ADN with equivalent experience; BSN must be obtained within 5 years of starting in the role. At least three years of experience in a clinical setting, ambulatory, or post-acute care. Care coordination experience preferred. Licensure/Certification: Current licensure as a registered nurse by the Maryland Board of Nursing. Working Conditions, Equipment, Physical Demands: Exposure to blood-borne pathogens is reasonably expected. Physical demands are classified as medium work. Reasonable accommodations will be made to enable individuals with disabilities to perform essential functions in accordance with the Americans with Disabilities Act. The above job description provides an overview of the role's functions and requirements. It is not exhaustive, and additional duties may be assigned as necessary.

#J-18808-Ljbffr