Job Details

The Inpatient Care Manager-Registered Nurse applies leverages nursing expertise to coordinate comprehensive care for a designated patient population across the continuum of care. This role involves assessing, planning, implementing, and evaluating individualized care plans while ensuring safe and timely discharge planning. The Inpatient Care Manager-Registered Nurse serves as a clinician, care manager, and educator, collaborating with the interdisciplinary team to achieve high-quality, cost-effective outcomes. Additionally, the individual actively manages resources to minimize unnecessary utilization and supports performance improvement initiatives to enhance patient care and system efficiency.

Job Duties

• Conducts comprehensive assessments at the patient entry to determine anticipated length of stay, discharge needs, and resources; develops and implements individualized plans of care and transition plans in collaboration with the multidisciplinary team.
• Coordinates safe and timely discharge planning, including securing post-acute authorizations, arranging transportation, homecare, and facility placements, and facilitating transfers when needed.
• Monitors and manages patient progress through daily review, participating in multidisciplinary rounds, initiative-taking identification and resolution of barriers to discharge. Documents all relevant information accurately and timely in the electronic medical record, adhering to departmental policies and compliance standards.
• Advocates for patients and families, addresses clinical, educational, and psychosocial needs while ensuring their preferences are reflected throughout the care continuum.
• Collaborates with multidisciplinary healthcare teams and provides the patient and/or family in the development and implementation of plans. Coordinates team and/or family conferences when necessary to facilitate patient’s care progression. Refers patient/significant other to community-based services/resources to meet patient’s continuum of care needs.
• Communicates effectively with physicians, patients, families, and team members to facilitate referrals, authorizations, and resolution of medical necessity issues and coordination of transition and discharge planning.
• Assists patients/families with self-management through education via in person visits, telephonic and electronic engagement and encourages and supports patient adherence to their discharge care plans.
• When necessary, initiates medical assistance application in a timely manner, as needed, or ensure medical assistance application has been initiated by identified external agencies, as needed. Follows up with identified external service regarding application.
• Maintains current knowledge of Medicare, Medicaid, and other payer systems, including benefits, reimbursement methodologies, and conditions of participation.
• Delivers required regulatory notices, within established times (as applicable to facility).

Minimum Qualifications

• Bachelor’s Degree Nursing
• 3 years experience in one of the following settings: care coordination, disease management, home health care, hospital, or physician office setting and 1 year prior electronic medical record (EMR) experience.
• Ability to incorporate strategies for interacting with persons from diverse backgrounds.
• Ability to set priorities to coordinate care plans efficiently.
• Knowledge of computer applications and analytical tools.
• Knowledge of nursing theory and application of learning theory.
• Proven leadership skills.
• RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire or RN - Licensed Registered Nurse_NJ - State of New Jersey Upon Hire.

Preferred Qualifications

• Master’s Degree Nursing
• Familiar with EHRs: EPIC
• ACM - Accredited Case Manager - American Case Management Association within 3 Years or CCM - Certified Case Manager - Commission for Case Manager Certification within 3 Years.

Additional Qualifications

• Current RN License in state of practice required.

Physical Demands

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer

This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Rotating (United States of America)

Worker Sub Type

Regular

Employee Entity

Thomas Jefferson University Hospitals, Inc.

Primary Location Address

2301 South Broad Street, Philadelphia, Pennsylvania, United States of America

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.