RN Care Manager (PRN)

RN Care Manager (PRN)Variable (United States of America) Employment Type PRN/ Resource Compensation: Hourly; flat rate $43/hr Primary Location Main Hospital - Grand Rapids, MI Department Name Care Management Summary Provides care management services to all patients and families to promote optimal functioning throughout the rehabilitation process. Maintains current with clinical practice through continuing education, research, and program development. Essential Job Responsibilities Provides care management services to patients and families. Provides an initial psychosocial assessment of patient and family functioning, adjustment to disability, health literacy status and coping skills. Provides education to facilitate adjustment, problem solving, and the development/implementation of an appropriate discharge/transition plan. Communicate with patients and families/supports to promote participation in the development and execution of the plan of care. Acts as an internal case manager and functions as liaison with external case managers, providers and funding sources to maximize patient satisfaction, quality, and cost-effective outcomes. Coordinates highly effective level of care transitions from inpatient to community-based levels of care and services, such as: outpatient rehabilitation, home care, hospice, school, vocational rehabilitation, counseling, etc. Oversees the patient follow up process to insure highly durable outcomes. Documents patient/family status, progress and discharge status through initial evaluation, progress notes, and discharge summaries according to established time standards. Identify and remove barriers to the discharge/transition process by: Identifying complex discharge/tr