Overview RN Case Manager - Days at INTEGRIS Health in Oklahoma City, OK. The Case Manager is responsible for clinical and financial outcomes for an assigned caseload, coordinating and monitoring resource utilization to achieve optimal patient outcomes and financial goals. This role supports discharge planning and transitions of care while adhering to safety and regulatory standards. INTEGRIS Health is an Equal Opportunity/Affirmative Action Employer.
This position is full-time days with the Case Management team. The organization highlights increased compensation plans and enhanced benefits for eligible caregivers, including front-loaded PTO, paid short-term disability, retirement matching, and paid family leave. The mission is to be The Most Trusted Partner for Health.
Responsibilities Completes a comprehensive assessment of patients’ clinical, psychological, and financial needs using all available resources.
Recommends and coordinates timely transfers to appropriate levels of care as indicated by clinical needs and utilization criteria.
Develops, implements, evaluates, and revises discharge plans, including referrals to other health care and community organizations.
Communicates discharge care plans and changes to patients, families, and appropriate healthcare professionals.
Assists physicians and hospital staff in appropriate resource utilization and facilitates timely discharge planning.
Coordinates services between hospital departments to facilitate timely discharge.
Conducts concurrent review of patient records on admission and as determined by clinical condition.
Applies utilization criteria to determine appropriate resource utilization.
Notifies internal and external contacts of utilization issues affecting patient care or reimbursement.
Facilitates patient transfers in accordance with hospital policies and applicable state/federal guidelines.
Acts as a resource/advisor to physicians regarding discharge planning, medical record documentation, and resource utilization and reimbursement.
Integrates and manages established care pathways to enhance clinical effectiveness and resource management.
Maintains knowledge of CMS regulations, Medicare/Medicaid, managed care, and other payer regulations and limits.
Provides education for patients, families, and healthcare professionals regarding payer regulations and coverage.
Develops and maintains knowledge of hospital and community resources to determine the most appropriate level of care that conserves patient, hospital, and payer resources.
Identifies opportunities to reduce the cost of patient care without compromising quality or outcomes.
Participates in data collection for utilization and Quality Improvement reporting, collaborating with patients, families, physicians, hospital staff, and others involved in patient care.
Specialty: Mental Health Only Leads age- and developmentally-appropriate patient education and recreational groups addressing emotional, physical, and environmental needs of Mental Health and/or Chemically Dependent patients.
Documents daily in patient charts for groups facilitated and assists with discharge planning for placement and treatment following discharge.
Participates in developing patient plans of care and attending treatment team meetings; writes treatment plans with program staff and physicians.
Assists in utilization review by obtaining clinical information from insurance companies to authorize treatment.
Acts as a patient advocate for patients and others involved in care; assists in marketing program services to appropriate entities.
Completes Emergency Detention paperwork and ensures distribution and receipt by designated individuals.
Provides physician-ordered therapy in individual, family, and marital areas as ordered.
Develops and facilitates psychotherapeutic groups appropriate to age and development.
Reviews and notes physician orders; monitors medications and educates on use and side effects; monitors vital signs as directed by orders.
Assesses patients for admission appropriateness to the program.
INTEGRIS Certified Case Management Only Documents and communicates patient progression through the continuum of care using electronic, written, and verbal means.
Alerts team members to challenges encountered throughout the continuum of care.
Manages evolving calendar commitments in the best interest of the patient and organization.
Acts as liaison between patient, medical provider, and organization to achieve positive outcomes.
For INTEGRIS Decisions Only Leads age- and developmentally appropriate patient education and treatment planning for Behavioral Health and/or Addiction Recovery patients.
Participates in writing treatment plans with program staff and physicians.
Assists in utilization review by contacting insurers for authorization of treatment.
Serves as patient advocate for patients and involved individuals; completes Emergency Detention paperwork as required.
Processes orders/refills and laboratory requests by physicians; monitors medications and vital signs.
Provides referrals for patients who are assessed but do not enter the program.
Completes a comprehensive Initial Mental Health Assessment of patients’ clinical, psychological, and financial needs using all resources.
Attends and participates in treatment teams.
The Case Manager reports to the Director of Case Management Services and meets established deadlines, maintains competencies, and collaborates with all disciplines. Mental Health staff may assist with physical restraint using the Mandt System. This position may have additional physical demand or respiratory fit test requirements. On-call as scheduled; potential exposure to infectious diseases and other hazards is possible. All applicants will be considered regardless of protected status under applicable laws.
Qualifications REQUIRED QUALIFICATIONS
EXPERIENCE:
5 years of experience in clinical settings (e.g., home health, inpatient, physician office, clinic)
LICENSE/CERTIFICATIONS:
BLS (Basic Life Support) issued by American Red Cross or American Heart Association within 30 days of hire
RN (Registered Nurse) currently licensed in Oklahoma or with an eNLC multistate license
SKILLS:
Excellent interpersonal communication and collaboration skills
Computer experience
Must communicate effectively in English. Incumbents may operate an INTEGRIS-owned or personal vehicle and must have an Oklahoma driver’s license with an acceptable driving record.
Preferred Qualifications
EXPERIENCE:
Experience with managed care and payer/provider requirements
EDUCATION:
Bachelor’s of Science in Nursing
LICENSE/CERTIFICATIONS:
Case Management Certification