RN Case Mgr - FT- 12 hrs - Integrated Care Management -IBMC ED
Company: Integris Health
Location: Oklahoma City
Posted on: February 24, 2021
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Job Description:
RN Case MgrJob Code: 1318Position 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
RehabRequired 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, Oklahoma City , RN Case Mgr - FT- 12 hrs - Integrated Care Management -IBMC ED, Executive , Oklahoma City, Oklahoma
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