Rewarding career. Competitive salary. Outstanding benefits.
Duties & Responsibilities
Professional Performance
Emulates the standards of practice for both Case Management and one's professional discipline.
Promotes a continuous learning and performance improvement mindset. Shares peer-reviewed, evidence-based findings with colleagues to integrate knowledge into professional practice. Use evidence-based, comprehensive care plans to manage patients.
Participates in meetings and committees as assigned, including Care Coordination & Utilization Committee.
Contributes to decision-making and decision support as a member of the interdisciplinary team.
Care Advocate
Advocates on behalf of patients/family/caregivers for service access or creation, and for the protection of the patient's health, well-being, safety, and rights. Identifies the legal decision maker (patient or surrogate).
Ensures patient or surrogate receives information on benefits, risks, costs, and treatment alternatives, including the option of no treatment.
Promotes and supports the patient's self-determination in care decisions and assists the health care team's understanding of and respect for the patient's or surrogate's choice.
Promotes and engages in culturally competent care.
Demonstrates the ability to balance resources with patient preferences.
Ensures that suspected cases of abuse, neglect, or exploitation have been referred/reported to the appropriate parties and/or agencies.
Utilizes the ethics committee or other resources to address bioethical issues impacting patient care.
Promotes the understanding and use of advanced care planning and ensures patient goals of care are respected.
Appropriately educates patients and families regarding insurance coverage and financial assistance available.
Care Coordination
Facilitates communication between patients, family, community agencies, and interdepartmental staff to arrange appropriate discharge planning and/or psychosocial intervention.
Conducts effective family conferences to discuss an appropriate discharge plan.
Actively and effectively participates in daily interdisciplinary collaboration to develop the most appropriate discharge plan.
Manages cost of care with the benefits of patient safety, clinical quality, risk, and patient satisfaction to provide recommendations and decisions that ensure optimal outcomes.
Educates patients/families/caregivers on the financial impact of their care and treatment options.
Facilitates timely progression to the appropriate level of care.
Identifies and addresses avoidable delay practice patterns that may require modification to support cost-effective care. Uses the escalation process as needed.
Conducts individualized clinical evaluations of patients, their health needs, and concerns; develops personalized action plans, provides education, and issues referrals for care management programs; monitors patients' progress in meeting established goals and modifies care plans accordingly.
Accurately completes referrals and/or applications to assist patients and families, i.e., Medicare, Medicaid, food stamps, energy assistance, rental assistance, WIC, First Steps, GAU, ADATSA, Uncompensated Care Services, Lifeguard, Home Health, Medical Supplies, Council on Aging, Home Care agencies.
Thoroughly documents all collaboration, counseling, referrals, family conferences, etc.
Care Management
Engages with providers and partner organizations to promote WHMC's Swing Bed Program.
Complies with regulatory requirements for patient status, length of stay, and medical necessity to ensure patients receive their care at the right level, place, and time to promote optimal health, healing, or comfort.
Utilization Review
The RN performing UR communicates with any admitting provider regarding the appropriate level of care using criteria from UR software for the patient on admission and throughout their hospital stay. (Final decision on patient status is the responsibility of the provider who is admitting or assigned to the patient). Adhere to regulations
o Completes clinical review in the EHR system utilizing UR software per payer request and/or status and sends pertinent clinical information to the payer via eFax, HER fax, or payer portal for Medicare Advantage, Medicaid HMO, and commercial plans per payer policy.
Care Plan Development
o Collaborates with the physician, social services, and other disciplines regarding changes in the patient's medical condition, status, length of stay, and discharge plans.
Care Review
o Directly communicates via fax, phone, email, and/or letter with commercial payers regarding medical status, payment, and anticipated length of stay.
o Communicates directly with Social Services/Discharge planner regarding all discharge plans.
Required
Active RN license
Associates or higher degree in nursing or related healthcare discipline.
Minimum 3 years of nursing experience.
BLS (AHA) within thirty (30) days of hire and maintained while employed.
Experience using Electronic Health Record for patient documentation.
Previous case manager experience and working knowledge of public/private payor models and financial aid resources.
Preferred
Bachelor's degree in nursing.
Specialty nursing certification (Accredited Case Manager credential, ACM-RN).
If you are looking for a rewarding career with a great team, you'll enjoy your career with us!
Position Details
Hours per week: 40
Employee Status: Regular Full Time
Shift: Day Shift (United States of America)
Pay Range: $40.00 - $69.50
Compensation: New hires should expect to start at the lower end of the range; actual pay offered will vary based on years of experience.
Employee Benefits
Our benefit package includes medical, dental, vision, life insurance, and retirement options (403(b) & 457). Medical insurance coverage begins on day one and is available to both full time and part time employees. Additionally, employees receive discounts on medical services provided by Whitman Hospital and Medical Clinics. Differentials apply for evening, night, and weekend shifts. Our unique PTO plan enables employees to increase their accrual with each year of service!