Remote Case Manager (RN) – Tennessee

RN Professional

Jackson

Tennessee

0 – Day (United States of America)

Manage a workload of patients in an outpatient base program to coordinate patient’s care and help manage the process to improve readmissions and help decrease ED overutilization through telehealth. Work closely with the patient’s physicians and other departments to coordinate care, identify opportunities for improvement of patient care, and assure accurate documentation for appropriate reimbursement where necessary. Assists with education of patients in the virtual care model through remote patient monitoring of various disease states to include Covid-19, diabetes, congestive heart failure, chronic obstructive pulmonary disease and asthma. Collaborates with other disciplines to identify and assist with patients’ needs and to help facilitate the education of patient through an outpatient process to become better equipped to manage their chronic diseases. Through clinical care coordination, drives efficient utilization of resources to reduce length of stay, improve patient flow, throughput and transitions of care, limits variation by applying innovative and evidence based practice and to reduce the risk of readmission.
Must have excellent verbal communication skills and pleasant telephone voice. Minimum of 5 years of clinical experience preferred. Must have completed diploma program, ASN, or BSN.

• Utilizes computer systems to organize daily workloads.
• Performs review of patients for appropriateness of care and assessment.
• Applies screening criteria on all clients and works closely with all patients/families to ensure they have the information and education needed to move forward in their disease process with an overall goal of decreasing the readmission rates and ED admissions for certain disease states.
• Documents certification information, clinical and discharge plan accurately in computer system.
• Notifies and consults with physicians regarding patient’s needs as it relates to their care.
• Work with other disciplines to coordinate patient care and help identify and utilize resources to help facilitate patient care across the continuum.
• Documents accurately and timely in designated computer system of interventions with patients/families to include statement of nature of referral, brief statement of plan, communication with physicians, and follow-up.
• Identify and report up through management any physician or system trends which cause delays in treatment, and other causes of frequent readmissions.
• Refers all quality issues to appropriate departments.
• Attends monthly staff and team meetings.
• Assumes roles in assessment physical, psychosocial, and economic needs for transition of care planning to a variety of levels of care; delegate to others as appropriate.
• Communicates telephonically and electronically with outpatient providers in an effort to enhance the continuum of care.
• RPM Case Manager Nurse will perform specific education that is in-line with the WTH Remote Patient Monitoring education protocol.
• Remote patient monitoring nurse will need to be able to establish an open and compassion-based rapport with patients who have been discharged to their home from an acute care setting.
• Nurse will need to coordinate follow-up appointments and care for patients with appropriate physicians and other healthcare providers.
• Nurse will need to alert the appropriate providers when a patient’s condition has changed or warrants medical attention.
• Will serve as a patient advocate and point of contact for the patient to ensure continuity of care.
• Remote patient monitoring nurse will need to be able to connect patients to various resources in the community as needed, working with the social worker to assist patients in social determinants of health to include, but not limited to transportation to physician/provider appointments, access to medications, food, health care, financial assistance.
• Will need to support various projects or work as department needs and goals change.
• Nurse will need to help clean/disinfect hospital issued equipment/DME to be sent to new patient.
• Nurse will need to act as charge nurse when the Manager/Director is not present.
• Will be expected to precept and mentor new employees as needed.
• Responsible for meeting and exceeding productivity and quality standards.
• Maintain awareness of changes/updates within the WTH Virtual Care department by attending department meetings and reading emails.
• Performs other duties as assigned or required.