RN Case Manager - Full-time

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RN, Case Manager - Full-time

Department:

Case Management

Location:

Rio Rancho, NM

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Job Summary and Scope

The Registered nurse case manager is responsible for facilitating individualized service delivery to patients in the acute care setting from admission through discharge in collaboration with the patient, families, care givers, physician, nursing staff, social worker, case manager assistant, utilization review nurse, and the multidisciplinary care team. The registered nurse case manager will utilize planning, coordination, implementation, and evaluation of health care services in providing quality and cost effective health care services throughout the continuum of care. Case Managers may work in the Emergency Department, inpatient units, or any other area within the hospital as deemed appropriate by the leadership.

Essential Functions:

POLICIES AND PROCEDURES - Maintain established departmental policies and procedures, objectives, and quality assurance programs.

PROFESSIONAL DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops.

The RN case manager is responsible for the collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s discharge needs through communication and available resources to promote quality cost-effective outcomes

The RN case manager reviews the treatment plan for appropriateness of admission status as inpatient or observation status utilizing Utilization Review clinical care guidelines screening criteria.

Make timely and appropriate referrals for post-acute services including home care, durable medical equipment, LTAC, acute rehabilitation facilities and skilled nursing facilities to assigned patients. Identify change in patient condition and assist with or institutes appropriate actions in a timely manner.

Promote patient's independence by incorporating and engaging patients and families to participate in individualized discharge preferences and establishing patient care goals, coordinating family meetings, teaching patient, friends, and family to understand medical condition, medications, and self-care skills; and answer questions as needed. Resolve patient problems and needs by utilizing multidisciplinary team strategies.

Escalates complex cases to director of case management.

Increase patient satisfaction (HCAHP) scores through the use of AIDET and departmental initiatives.

Complete assigned risk assessments, and discharge summary documentation to provide continuity in communication among multi-disciplinary team. Maintain patient confidence and protect operations by keeping information confidential and medical records complete and accurate. Adheres to standard documentation process by charting in patients electronic medical record and department records.

Assures quality of care by adhering to quality safety goals, policies and procedures, regulatory and legal compliance, therapeutic standards, measuring of health outcomes against patient care goals and standards; makes or recommends necessary adjustments.

Compliance in RN Case Manager standard work duties.

Participate in the hiring, orientation, precepting, evaluation, and/or retention of co-workers.

Serves as liaison for the interdisciplinary team, the patient, and family to ensure a timely, smooth, and clinically appropriate discharge plan.

The Case Manager also maintains communications with the payer at the time of admission and throughout the hospitalization to ensure necessary approvals for post-acute care and clarification of benefits. Facilitates retrospective reviews and approvals for care whenever necessary, and implement and coordinate discharge plans utilizing available and appropriate community resources.

Perform miscellaneous job-related duties as assigned.

SRMC Core Values

Integrity:

Our words and actions match our values

To Serve:

We put the needs of others before our own

Excellence:

We strive to exceed expectations and/or standards in every activity, every encounter, and every initiative

Safety/Quality:

We provide evidence based care, programs, services, and an environment that achieves the best outcomes

Teamwork:

We enjoy the ability and power to work collaboratively to deliver exceptional service

Accountability

Maintain state and federal regulatory standards relating to discharge planning and Utilization management.

Coordinate effective patient through put and enhance timely discharges in accordance with Length of stay (LOS) benchmarks

Communication Skills

Must have excellent verbal and written skills

Required Qualifications

Knowledge of Medicare and Medicaid regulatory requirements and Joint commission standards

Knowledge of insurance provider and other third party payers.

Knowledge in Interqual or Milliman care guidelines

Knowledgeable in computer skills, Microsoft Word, Excel, Outlook, Cerner, Epic and Case management systems as Curaspan, Midas, Allscripts

Must have experience in discharge planning and a working knowledge of alternative delivery systems including home health, durable medical equipment, rehabilitation, extended care facilities, and skilled nursing facilities.

Must be able to multitask and work independently

Education/Experience

Education:

Graduate of an accredited school of nursing

Licenses/Certifications:

Registered nurse license in the state of New Mexico

Work Experience:

2 years case management or medical surgical experience

Preferred Educational/Experience Requirements:

BSN preferred

Case Management Certification (CCM) or American case management association certification (ACM) preferred or at least 3 years after hire

Supervision

Works under the direction of the Director of Case Management

Conditions of Employment

Must pass a pre-employment criminal background check, reference checks and a post offer drug screen.

Must be employment eligible as verified by the U.S. Dept. of Health and Human Services Office of Inspector General (OIG) and the Government Services Administration (GSA).

Tuberculin Skin Test required annually

Hospital required vaccinations

Hospital required competencies

Working Conditions

Typical office and/or patient care, acute care hospital environment.

Must be able to travel locally between facilities and within the surrounding community.

Occasional exposure to minimal physical risk

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Company info

Sandoval Regional Medical Center