About the job
Luminis Health seeks a Registered Nurse Case Manager for its Annapolis, MD location. Reporting to the Clinical Director, this RN will coordinate patient care across the healthcare continuum, focusing on safe and timely transitions. The role involves assessing, planning, implementing, and evaluating care options tailored to each patient's needs, including social factors that affect overall well-being. The Case Manager also manages insurance denial reviews for Medicare, Medicaid, and commercial payers.
Key Responsibilities
- Identify and prioritize patients who need care management using a holistic, multidisciplinary approach. Consider biopsychosocial, functional, cultural, spiritual, and financial factors.
- Use motivational interviewing and other strategies to engage patients, support self-care, encourage treatment adherence, 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 to Physician Advisors when needed.
- Manage observation stay patients proactively. Ensure timely testing and treatment, and facilitate appropriate conversion to inpatient status or discharge.
- Develop and coordinate transition plans for patients moving to home care, community care programs, hospice, or palliative care. Complete required documentation and handovers, and prepare patients and families for transitions from various units.
- Maintain detailed documentation reflecting each patient's physical and functional limitations, psychosocial characteristics, and educational needs of patients and families.
