Inpatient RN CM

Essential Functions

• Conducts comprehensive assessments, establishes appropriate care plans, and initiates interventions within required timeframes. Collaborates and negotiates with patients, families, and interdisciplinary teams to achieve patient and organizational goals. Uses patient/family strengths in problem‑solving and actively involves them in decision‑making from admission through discharge.
• Provides continuity of care and discharge planning in compliance with regulatory standards, ensuring coordinated, relevant services based on assessed needs. Participates in communication processes that support smooth transitions during transfers for patients, families, and staff.
• Delivers case management services related to healthcare, finances, housing, family conflict, illness adjustment, or other needs within department scope. Manages family dynamics and crisis situations professionally while using community resources effectively. Educates patients/families on service access and utilization.
• Initiates timely referrals to internal and external resources to support progression of care and transition needs. Documents discharge planning, utilization review, and related interventions per department/medical center standards. Completes accurate concurrent and retrospective reviews using approved criteria.
• Communicates effectively with the care team, working closely with Social Work and support personnel to establish safe, effective plans of care. Actively participates in MDR, collaborates with hospital departments, and resolves discharge barriers to avoid delays in care delivery.
• Collaborates with leadership and medical staff, including managers, physicians, medical directors, and advisory teams, to address issues related to best practices and care progression. Refers cases to physician advisors when necessary to ensure appropriate status and regulatory compliance.
• Maintains knowledge of healthcare regulations, reimbursement practices, community resources, and factors affecting length of stay. Completes UM activities, including clinical updates to payers, data collection, denial coordination, avoidable delay management, and timely delivery of CMS notices per guidelines.
• Builds and maintains productive relationships with community-based agencies, representing Advocate Health Care positively. Collaborates with Advocate Ambulatory Care Management and Continuing Health teams to support shared patient‑focused goals.
• Serves as an educator and expert resource for medical and hospital staff regarding admission status, acute care criteria, utilization management, care coordination, discharge planning needs, and regulatory requirements.

Qualifications

Education

• Graduate of an accredited School of Registered Professional Nurses
• BSN preferred; MSN encouraged

Experience

• 3 years of related nursing experience preferred
• Clinical experience with the assigned patient population
• Extensive knowledge of disease processes and clinical outcomes
• Case Management background or experience preferred
• Strong critical thinking and analytical skills preferred
• Appropriate professional certification preferred within 3 years of hire

Licensure/Certification

• Current registration as a Registered Nurse in the applicable state
• Case Management certification encouraged