Integris Health: Rn Case Manager - Ft Days - Baptist Medical Center, Okc, Ok
Company: Integris Health
Location: Oklahoma City
Posted on: January 15, 2021
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Job Description:
Job DescriptionRN 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 design About Integris
Health
Keywords: Integris Health, Oklahoma City , Integris Health: Rn Case Manager - Ft Days - Baptist Medical Center, Okc, Ok, Healthcare , Oklahoma City, Oklahoma
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