RN Care Management

Description

Job Description

PeaceHealth is seeking a RN Care Management for a Per Diem/Relief, 0.00 FTE, Day position.

The salary range for this job opening at PeaceHealth is $53.38 – $80.08. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Job Summary

Coordinates and facilitates the discharge plan of care and service of selected patient populations across the continuum of illness, promote effective utilization and monitoring of health care resources, and assumes a leadership role with the interdisciplinary team to achieve optimal clinical, financial, and satisfaction of outcomes. Acts as intermediary between hospital and third-party payors to ensure patients receive appropriate medical services, and the organization receives appropriate and optimal reimbursement, in accordance with regulatory standards.

Essential Functions

• Reviews patient admission data within established timeframes of department, to determine the appropriate level of care in accordance with hospital-sanctioned industry standard criteria and/or other established criteria for other settings across the continuum of care.
• Assesses, develops, implements and monitors a comprehensive discharge plan of care through an interdisciplinary team process in conjunction with the patient and family in internal and external settings.
• Comprehensively assesses patients’ goals as well as their biophysical, psychosocial, environmental and discharge planning needs and financial status.
• Identifies key problems, strengths and resources to be addressed in the discharge plan of care, including needed resources post-discharge. Coordinates and facilitates those services.
• Ensures accurate documentation for patient’s continued hospital stay is established and maintained, coordinates necessary changes with attending physician and other team members as necessary to achieve optimal care and reimbursement.
• Communicates proactively and adeptly with members of the interdisciplinary team to ensure hospital and community resources are appropriately and effectively utilized on behalf of patients and their families.
• Facilitates interdisciplinary team meetings to improve quality, decrease cost and improve patient satisfaction.
• Coordinates documentation and clarifies necessary details with Patient Financial Services to assist in decreasing denials.
• Ensures the completion of documentation necessary for utilization assessments and communicates via electronic medical record information needed to justify continued hospitalization. Maintains any applicable care management databases.
• Performs concurrent review to determine correct admission status per insurance criteria, including Interqual or other industry standard criteria recognized by Medicare. Monitors and documents variance days, communicates with attending physician and UR Physician Advisor as indicated. Documents outcomes in appropriate locations.
• Communicates within designated time frames with third party payors in order to obtain authorizations and resolve payment issues on behalf of patients and families and the organization if applicable.
• May assume Palliative Care responsibilities as indicated, including facilitate and coordinate – pain and symptom management, POLST, family meetings, comfort care.
• Performs other duties as assigned.
  
  

Qualifications

Education

• Required: Degree from an Accredited School of Nursing
• Preferred: Bachelor of Science in Nursing
• Preferred: Master of Science in Nursing
  
  

Experience

• Required: Minimum of 3 years of Clinical nursing experience in an acute care hospital. Equivalent skilled nursing facility, outpatient case management, home health or hospice experience may be considered
• Preferred: Utilization management/quality management experience
  
  

Credentials

• Required: Registered Nurse In state of practice
• Required: Upon Hire Basic Life Support
• Preferred: Specialty Certification
  
  

Skills

• Third party reimbursement knowledge. (Preferred)
• Interpersonal skills to obtain and interpret information appropriate to patients’ needs and age as required for assessment range of treatment, and patient care. (Required)
• Skill and proficiency in applying highly technical principles, concepts, and techniques. Such proficiency is usually acquired through completion of a bachelor’s degree in nursing; any equivalent combination of education, training, and/or experience that fulfills the requirements of the position will be considered. (Preferred)
• Demonstrated ability to promote positive interpersonal relationships and patient/family centered work environment. (Required)
• Basic computer skills including MS Office applications (Required)
• Effective prioritization skills (Required)
  
  

Working Conditions

Lifting

• Patient handling no greater than 35 lbs. without the use of assistive equipment and/or devices (NIOSH).
• Fine motor skills to be able to grasp and control medical equipment and perform precise procedures.
• Push/Pull: Frequently up to 45 lbs. force (i.e., WOW, medical carts).
• Perform hands on CPR at least 20 mins using 100-125 lbs. of force (National Assoc. of EMS Physicians and AHA) Frequency should be seldom or occasionally.
• Ability to move around area with frequent sitting.
• Bending/ stooping/ squatting/ reaching/ kneeling frequently.
• Lifting (non-patient) up to 20 lbs. occasionally and 5 lbs. frequently.
  
  

Environmental Conditions

• Exposure to biohazard, body fluids and airborne particles.
• Must be able to complete tasks in a noisy environment.
  
  

Mental/Visual

• Vision and hearing required within normal limits (glasses, contacts, hearing aids permitted).
• Ability to communicate and exchange accurate information.
  
  

PeaceHealth is committed to the overall wellbeing of our caregivers. The benefits included in positions less than 0.5 FTE are 403b retirement plan for caregiver contributions; wellness benefits, discount program, and expanded EAP and mental health program.

See how PeaceHealth is committed to

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.