RN Care Manager -Full Time -Day Shift- Bass Baptist Hospital ,Enid, Ok
Company: INTEGRIS Health
Location: Enid
Posted on: February 16, 2021
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Job Description:
RN Case Mgr Job Code: 1318 Position Summary: The Case Manager is
responsible for the clinical and financial outcomes for an assigned
caseload of patients as appropriate. The Case Manager facilitates
patient care during the hospitalization by managing, coordinating
and monitoring resource utilization to achieve optimal clinical
outcomes and financial goals. The Case Manager is responsible to
proactively plan, coordinate and negotiate efficient patient
movement throughout the continuum of care. In general, the Case
Manager functions in the role of clinician, educator, researcher,
manager and advocate to serve the best interests of the system and
patient. Adheres to National Patient Safety Goals as appropriate
based on the level of patient contact this position requires.
INTEGRIS is an Equal Opportunity/Affirmative Action Employer. All
applicants will receive consideration regardless of membership in
any protected status as defined by applicable state or federal law,
including protected veteran or disability status. Essential
Functions: The RN Case Manager responsibilities include, but are
not limited to, the following: Completes a comprehensive assessment
of patients clinical, psychological and financial needs utilizing
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, as necessary, a plan for discharge, including referrals to
other health care and community organizations based on needs
assessment. Communicates discharge care plan, and any changes in
the plan to patient, family and all appropriate healthcare
professionals. Assists physicians and hospital staff in appropriate
utilization of resources through application of utilization
criteria and facilitating timely discharge planning for patients.
Coordinates services between hospital departments to facilitate
timely patient discharge. Conducts concurrent review of patient
records on admission to the hospital and as determined by the
patient's clinical condition. Applies utilization criteria
accurately in order to determine appropriate utilization of
resources. Notifies designated internal and external contacts of
utilization issues that may affect patient care and/or
reimbursement. Facilitates patient transfers to other health care
organizations in accordance with hospital policies and
all-applicable state and federal guidelines and regulations. Acts
as a resource/advisor to physicians regarding discharge planning,
medical record documentation, and all issues that may affect
resource utilization and reimbursement. Integrates and manages
established pathways, where available, to enhance clinical
effectiveness and clinical resource management. Maintains knowledge
and understanding of CMS regulations, Medicare/Medicaid, managed
care and other payer regulations and benefit limits. Acts as a
resource and provides education for patients, their family members
and all health care professionals regarding HCFA regulations,
Medicare, Medicaid, managed care and other payers. Develops and
maintains knowledge and understanding of hospital and community
resources, and facilitates use of most appropriate level of care to
conserve patient, hospital, and payer resources. Identifies
opportunities to reduce cost of managing patient care without
impacting quality or outcomes. Participates in collecting and
recording data for utilization and Quality Improvement reporting.
Works collaboratively and professionally with patients, family
members, and physicians, hospital staff and other individuals and
agencies involved in providing patient care. Mental Health Only:
Leads age and developmentally appropriate patient education and
recreational groups to address the emotional, physical and
environmental needs of Mental Health and/or Chemically Dependent
patients. Provides documentation daily in patients' charts on each
group facilitated. Facilitates discharge planning to assist
patients in placement and treatment following discharge.
Participates in the development of patient plans of care to address
goals of the patient (emotional, physical, spiritual,
environmental) by attending treatment team meetings Participates in
the writing of treatment plans with other program staff and
physicians on hospital approved form. Assists in utilization review
process by contacting patients' insurance companies to provide
clinical information to authorize patient treatment. Serves as a
patient advocate in the patients' needs, as well as those
individuals involved with patients (as relevant). Assists in the
development and execution of marketing the program services to
appropriate entities (outpatient therapists, primary care
physicians, inpatient programs, etc.). Completes or facilitates the
completion of Emergency Detention paperwork, as well as ensure its
distribution and receipt by legally designated individuals.
Provides physician ordered therapy in the areas of individual,
family and marital sessions. Develops and facilitates age and
developmentally appropriate patient psychotherapeutic groups. Is
responsible for reviewing and noting physician orders. Monitors
patients' medications and provide education related to use and side
effects. Monitors vital signs as indicated by physician orders or
if deemed medically necessary. Assesses patients for
appropriateness of admission to the program. INTEGRIS Certified
Case Management Only: Documents and communicates in a timely
fashion patients progression throughout the continuum of care to
all necessary parties via electronic, written, and verbal means.
Apprises team members of challenges encountered throughout the
continuum of care via electronic, written, and verbal means.
Utilizing strong organizational skills, personally manage evolving
calendar of commitments in the best interest of the patient and
organization. Utilizing excellent interpersonal, collaborative, and
conflict resolution skills, act in the capacity of liaison between
the patient, medical provider, and the organization to achieve
positive outcome. Accountability: The Case Manager reports to the
Director of the Case Management Services. The Case Manager meets
established deadlines, attends required inservices, maintains staff
competencies and completes required documentation; collaborates and
works as a team player with all disciplines; presents a
professional image to all customers and patients. Mental Health
Case Managers report to the Unit Program Manager INTEGRIS Certified
Case Managers report to the Process Manager, Disability Mgmt. Jim
Thorpe Rehab Hospital: Reports to Mgr Post-Acute Care and Rehab
Required Physical Demands (Subject to Reasonable Accommodation):
Keyboarding/Dexterity: Frequently; activity exists from 1/3 to 2/3
of the time Standing/Walking: Occasionally; activity exists up to
1/3 of the time Strength (Lift/Carry/Push/Pull): Light (Exerting up
to 20 pounds of force occasionally, or up to 10 pounds of force
frequently) Talking (Must be able to effectively communicate
verbally): Yes Seeing: Yes Hearing: Yes Color Acuity (Must be able
to distinguish and identify colors): Yes Mental Health staff must
be able to assist with physical restraint of patients, utilizing
the Mandt System. This position may have additional or varied
physical demand and/or respiratory fit test requirements. Please
consult the Physical Demands Project SharePoint site or contact
Risk Management/Employee Health for additional information.
Environmental Conditions: Required to be on call as scheduled by
the department. Potential exposure to infectious diseases,
potential physical danger from disturbed/irate patients and
families. Emotional stress due to inability to control volume of
timing of referrals and necessity to respond to a wide variety of
demands and expectations from patients, families, physicians, and
other health care professionals. Occupational exposure to
bloodborne pathogens and other infectious materials as defined by
OSHA. All applicants will receive consideration regardless of
membership in any protected status as defined by applicable state
or federal law, including protected veteran or disability status.
Qualifications: 5 years experience in a variety of clinical
settings (e,g. home health, inpatient, physician office, clinic)
required. Experience with managed care and payer/provider
requirements preferred. Current licensure as a Registered Nurse
(RN) in the State of Oklahoma or current multistate license from a
Nurse Licensure Compact (eNLC) member state. BSN preferred.
Excellent interpersonal communication and collaboration skills.
Computer experience required. Windows preferred. Current Case
Management Certification preferred, at minimum attained within one
year of hire (INTEGRIS Certified Case Management only) Current
Driver's License issued by the state of Oklahoma.
Keywords: INTEGRIS Health, Enid , RN Care Manager -Full Time -Day Shift- Bass Baptist Hospital ,Enid, Ok, Healthcare , Enid, Oklahoma
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