Monitors and manages patient care to promote continuity of care, optimal outcomes, patient satisfaction, cost efficiency, and regulatory compliance. Collaborates with the multidisciplinary team, payors, and community resources; leads discharge planning and utilization review activities. Reports to the Director or Manager of Department.

• Consults regularly with nursing staff and the multidisciplinary team to evaluate patient status and appropriateness of care, including admission, length of stay, transfers, and discharge.
• Monitors patient and family satisfaction; responds to questions and complaints from patients, families, and payors.
• Leads and coordinates discharge planning, including patient transfers to other facilities and referrals to community resources; provides discharge education.
• Performs chart reviews to identify and address issues related to service delivery, patient outcomes and satisfaction, compliance, cost, and reimbursement.
• Communicates effectively with providers, payors, and ancillary services to remove barriers and ensure timely care progression.
• Accurately documents case management activities, plans, and outcomes.
• Participates in performance improvement and required continuing education.
• Supports department operations by working alternate shifts/units as needed; may be assigned on-call.
• Performs other duties as assigned.

Patient Populations Served: Neonate, Infant, Early Childhood, Late Childhood, Adolescent, Young Adult, Middle Adult, Older Adult. Protected Health Information Accessed: Demographic, Clinical, Insurance, Financial, Complete Medical Record. Exposure: Occupational exposure to bloodborne pathogens may be present. Physical Requirements (typical): Frequent keyboard data entry, sitting, standing, walking, and repetitive hand/arm movements; occasional kneeling, squatting, pushing/pulling and lifting/carrying up to 25 lbs; rare climbing or running. Vision demands include near/far vision and depth perception (constant); color distinction frequent; smell and taste rarely required.

Education: Associate’s Degree in Nursing required; Bachelor’s Degree in Nursing preferred. License/Certifications: Current RN license in state of practice; BCLS required. Skills: Critical thinking and decisive judgment; ability to work with minimal supervision in stressful environments. Proficiency learning/navigating multiple clinical software systems. Effective English communication (read, write, speak, and understand). Ability to complete the Skills Competency Checklist within 90 days of hire.