About the job
Luminis Health is hiring a Registered Nurse Case Manager in Annapolis, MD. Reporting to the Clinical Director, this position coordinates patient care throughout the healthcare continuum. The RN Case Manager focuses on safe, timely transitions and tailors care options to individual patient needs, taking into account social and environmental factors that influence well-being. This role also handles insurance denial reviews for Medicare, Medicaid, and commercial payers.
Key responsibilities
- Identify and prioritize patients requiring care management, using a multidisciplinary approach that considers biopsychosocial, functional, cultural, spiritual, and financial factors.
- Engage patients through motivational interviewing and similar strategies to support self-care, encourage adherence to treatment, and work toward optimal health outcomes.
- Apply evidence-based guidelines such as InterQual to ensure quality care, minimize variations, and avoid unnecessary costs. Confirm appropriate care levels, document clinical reviews and authorized days in Epic, and track actions to prevent denied days. Refer cases to Physician Advisors as needed.
- Proactively manage observation stay patients by ensuring timely testing and treatment, and facilitating conversion to inpatient status or discharge when appropriate.
- Develop and coordinate plans for patient transitions to home care, community programs, hospice, or palliative care. Complete required documentation and handovers, and prepare patients and families for transitions from various units.
- Maintain thorough documentation reflecting each patient's physical and functional limitations, psychosocial characteristics, and the educational needs of patients and families.
