Registered Nurse (RN) - Acute Care Case Manager, PRN, Days

Inspire health. Serve with compassion. Be the difference.\n\nJob Summary\n\nThe Hospital Care Manager (HCM) is a vital member of the care team focused on engaging and empowering patients. You will be responsible for managing patients' transitions from acute care settings while ensuring a seamless alignment with their long-term care plans. Collaborating with physicians, you will lead a multidisciplinary team, including clinical staff and payers, to deliver quality, effective, and efficient care tailored for each individual.\n\nKey Responsibilities\n

• Collaborate with attending providers during hospitalization to ensure optimal utilization of clinical resources, maximizing care efficiencies for patients and their families.\n
• Identify and address social determinants of health that may adversely affect patient outcomes, coordinating clear communication among the interdisciplinary team.\n
• Proactively tackle systemic issues that hinder diagnostic or treatment processes, documenting obstacles and driving change for improved performance.\n
• Expertly navigate value-based care to ensure that patient-focused longitudinal plans align with the goals of patients and caregivers.\n
• Assess psychosocial risk factors for patients and families, evaluating coping mechanisms and support systems.\n
• Stay informed on clinical knowledge regarding body systems and expected outcomes, as well as changes in regulatory requirements regarding care management.\n
• Ensure medical necessity and appropriateness of care plans in line with hospital Utilization Review Policies.\n
• Guide the team through complex compliance and insurance processes, regularly coordinating with third-party payers.\n
• Act as a resource for patients and families regarding their rights, particularly in cases of care denial or changes in medical necessity.\n
• Advocate for patient empowerment, enabling independence in healthcare decisions and access to needed services.\n\nMinimum Qualifications\n
• Bachelor's degree in nursing.\n
• Three (3) years of acute care nursing experience; one (1) year of case management experience preferred.\n\nRequired Licensure\n\nLicensed to practice as a Registered Nurse in South Carolina.\n\nAdditional Qualifications\n
• Preferred : Accredited Case Manager (ACM) or Certified Case Manager (CCM).\n
• Knowledge of Medical Necessity Criteria preferred.\n\nWork Shift\n\nDay (United States of America)\n\nLocation\n\n1510 Richland Hospital\n\nDepartment\n\nHospital Case Management\n\nJoin our team at Prisma Health, where we are committed to transforming healthcare for the betterment of the communities we serve.