Registered Nurse RN Case Manager

Banner Health • Colorado Springs, CO

14d • $35 - $59 • Hybrid

About The Position

Banner Plans & Networks (BPN) is an integrated network for Medicare and private health plans. Known nationally as an innovative leader, BPN insurance plans and physicians work collaboratively to keep members in optimal health while reducing costs. Supporting our members and vast network of providers is a team of professionals known for innovation, collaboration, and teamwork. If you would like to contribute to this leading-edge work, we invite you to bring your experience and skills to BPN. Transitional Care Management (TCM) is a program designed to facilitate discharge from a hospital or facility, back to home. Patients are discharged, and called within 2 business days of discharge, then they see their PCP within 14 days of discharge, and then Banner bills Medicare for TCM visit. The TCM RN works of a list of patients that have discharged. The RN reviews the record prior to calling the patient. RN calls the patient, reviews medications, discharge instructions, and medical follow up appointment times with them, and answers questions. We document in the record, according to guidelines. If the patient has ongoing issues, they can be referred to case managers within our department. Monday - Friday 8:00am - 4:30pm Mountain Time Must be located near Greeley, CO. Most work can be done remotely with occasional travel for on-site meeting. Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position provides comprehensive care coordination for patients as assigned. This position assesses the patients plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patients health care needs. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care.

Requirements

• Must possess knowledge of case management or utilization review as normally obtained through the completion of a bachelor's degree in case management or health care.
• Requires current Registered Nurse (R.N.) license in state worked.
• For assignments in an acute care setting, Basic Life Support (BLS) certification is also required.
• Requires a proficiency level typically achieved with 3-5 years clinical experience.
• Must have a working knowledge of care management, acute care and/or home care environments, community resources and resource/utilization management.
• Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills.
• Must demonstrate ability to work effectively in an interdisciplinary team format.
• For assignments in an acute care setting, must be able to work flexible hours and take rotating call after hours.
• Banner Registry and Travel positions require a minimum of one year experience in an acute care hospital and/or home care setting.
• Experience must include working in an acute care and/or home care setting within the past 12 months as a Case Manager in the specialty area.

Nice To Haves

• Certification for CCM (Certified Case Manager) preferred.
• Additional related education and/or experience preferred.

Responsibilities

• Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
• Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
• Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care.
• Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes. Assesses patient admissions and continued stay utilizing standard criteria. Identifies issues that may delay patient discharge and facilitates resolution of these issues.
• Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements.
• Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice.
• May supervise other staff.
• Has freedom to determine how to best accomplish functions within established procedures. Confers with supervisor on any unusual situations. Positions are entity based with no budgetary responsibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level