Case Management RN

Nemours Children's Health • $80K — $95K *
Wilmington, DE 19805In-Person
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Diploma/Associate Degree required; Bachelor's Degree preferred
  • Active Registered Nurse license in applicable state(s) mandatory
  • Case management or utilization management certification preferred
  • Minimum of five years progressive clinical experience in related healthcare roles
  • Experience in case management or utilization management is essential

Responsibilities

  • Assess inpatient and Emergency Department patients for discharge planning and access needs.
  • Collaborate with the interdisciplinary team to implement patient-centered discharge plans.
  • Monitor clinical progression and escalate issues affecting discharge timelines.
  • Support Utilization Management to ensure medical necessity and appropriate patient status.
  • Identify patients at risk for readmissions and coordinate follow-up care.
  • Communicate with patients and families to navigate barriers and adapt care plans.
  • Provide education to patients and families about the discharge process and needed follow-up resources.

Benefits

  • Work in a child-focused healthcare environment
  • Opportunity to collaborate with interdisciplinary teams
  • Commitment to improving patient and family satisfaction
  • Alignment with national case management standards
  • Access to professional development and certification programs
Full Job Description
Job Description

Nemours is hiring a Nurse Case Manager. The Nurse Case Manager (NCM)/Case Management RN is responsible for the coordination of care of individual patients in the Inpatient and Emergency Department acute care environment. Through the use of the nursing process, patient care will be assessed, planned, implemented and evaluated with consideration to the appropriate use of resources, anticipatory discharge and timely progression of care. The NCM will manage care with a focus on designated clinical, operational, and financial outcomes for aggregate patient populations. In collaboration with the interdisciplinary team and a family-centered process, the NCM will work to improve outcomes as measured by timely discharge from acute inpatient care, connection to post-discharge care/appointments, family/caregiver access to needed supplies, reduced readmission rates, and improved patient/family satisfaction. Discharge planning, transitions of care and outpatient care of patients within the continuum of care will be aligned with:
  • American Case Management Association Standards of Practice and Scope of Services (ACMA)
  • American Case Management Association Transitions of Care (ACMA)
  • Case Management Society of America Standards of Practice (CMSA)


The NCM is accountable for adherence to policies and procedures of Nemours Children's Hospital, Delaware, and other affiliated hospitals to which Nemours-delegated patients are admitted/seek care.

The NCM is expected to maintain all state and federal clearances for DE.

Qualifications:
  • Diploma/AD required; BSN preferred
  • Active Registered Nurse license in the applicable state(s) (required)
  • Case management or utilization management certification (preferred)
  • Minimum of five (5) years of progressive clinical experience, including utilization management, case management, or related healthcare operations


Primary Responsibilities:
  1. Assesses inpatient and Emergency Department patients for discharge planning needs, social drivers of health, gaps in care, and access to post-acute services and supplies (e.g., DME, home nursing).
  2. Collaborates with providers, social work, and the interdisciplinary team to develop and implement patient-centered plans of care and discharge plans, with a clear timeline and estimated discharge date.
  3. Monitors clinical progression and barriers to discharge; escalates issues to support appropriate level of care, length of stay, and resource utilization.
  4. Partners with Utilization Management to support medical necessity and correct patient status (inpatient vs. observation/OPER); supports denial prevention and appeals through timely, complete clinical documentation, educating providers around medical necessity/denials, and support for peer to peer reviews.
  5. Identifies patients at risk for unsafe transitions, high ED utilization, or readmission; completes transition assessments and coordinates follow-up care and appointments.
  6. Communicates with patients/families and the care team to address barriers, coordinate services, and adapt plans based on changes in clinical status or goals of care.
  7. Provides patient/family education on the discharge process, including follow-up needs, and medications/supplies; confirms understanding and documents education as appropriate.
  8. Initiates and coordinates referrals to internal and community resources to support discharge needs (e.g., home health, DME, transportation, pharmacy). Ensure timely and accurate delivery and fulfillment of discharge resources.
  9. Coordinates transitions of care with outside hospital/facility case management and care coordination teams, including discharge to home, transfer to another acute care facility, home services, or skilled nursing facility


About Nemours Children's Health

Nemours Children's Health Careers

There has never been a better time to explore the diverse job opportunities at Nemours Children's Health, a leading organization in pediatric healthcare. Nemours Children's Health is renowned for its commitment to innovation and excellence in child health services.

Work You’ll Do

Join Nemours Children's Health to assist in transforming pediatric healthcare and improving the lives of children across the nation. Nemours Children's Health stands at the forefront of medical innovation and patient care, making it an ideal environment for professionals looking to make a significant impact. Engage in meaningful work that combines cutting-edge technology, deep industry expertise, and a passion for enhancing children's health outcomes. Nemours Children's Health offers a unique position in the marketplace, enabling team members to lead in pediatric healthcare through advanced technology and innovative healthcare solutions. Collaborate with a dedicated team of healthcare professionals who are committed to driving change and fostering a culture of excellence and compassion.

Nemours Children's Health Employment Opportunities

The team is actively building its workforce to support and advance pediatric healthcare services. Nemours Children's Health offers a variety of positions, from clinical roles to administrative support, each contributing to the overarching goal of children's health and wellness.

Innovative Work and Career Growth

Nemours Children's Health is home to a vast network of healthcare professionals—each dedicated to pediatric care and committed to leadership and professional growth. The organization encourages continuous professional development and leadership training to ensure that team members are equipped to lead and innovate in their fields.

Be Part of a Diverse and Inclusive Team

Nemours Children's Health prioritizes diversity and inclusion, creating a welcoming environment where all team members can thrive. The organization offers diversity training and promotes a culture where different perspectives are valued and celebrated.

Future-Proof Your Career

Nemours Children's Health provides extensive support for career advancement, including professional development programs, certification support, and leadership training. The potential for growth within the organization is substantial, driven by a commitment to internal promotion and professional enrichment.

Explore Job Opportunities and Internships

Nemours Children's Health offers a range of job opportunities and internships, providing a pathway for those at the start of their careers to gain valuable experience in the healthcare industry. Positions are designed to harness the skills and enthusiasm of new entrants to the professional world, integrating them into a team that is passionate about children's health and well-being.

The Nemours Children's Health Network

By joining Nemours Children's Health, team members become part of a respected network known for its commitment to innovation and quality care. The collaborative environment ensures that all members have access to the tools and resources necessary to excel in their roles.

Stay Connected

Join the Team

Search open positions that match your skills and interests. Nemours Children's Health looks for passionate, curious, creative, and solution-driven team players. SEARCH NEMOURS CHILDREN'S HEALTH JOBS

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