Registered Nurse, RN | Case Manager

Hillsboro Medical Center•Hillsboro, OR

21h•$49 - $74

About The Position

Analyzes patient medical records concurrently and/or retrospectively for quality assessment and discharge planning criteria. Provides supportive documentation and clinical records to insurance carriers for authorization of services. Coordinates discharge plans and orders for patients leaving the hospital, including identifying needs for community services and making appropriate transition plans. The position requires creativity, problem solving, multitasking, prioritization, and the ability to work with minimal supervision. The Case Manager assesses patients’ clinical and discharge needs, develops individualized case management plans, coordinates appropriate services and resources, and collaborates with patients, families, hospitalists, multidisciplinary teams, social workers, vendors, and insurance carriers. The role supports safe transitions across the continuum of care and serves patients from neonate through geriatric populations. Relocation assistance is available up to $15,000. The stated pay range is $49.34 to $74.08 per hour.

Requirements

Associate Degree in Nursing, with at least three years of experience practicing as a Registered Nurse; alternatively, a Bachelor or Master of Science in Nursing with at least two years of Registered Nurse experience.
Current Registered Nurse license issued by the Oregon State Board of Nursing.
American Heart Association Healthcare Provider BLS certification.
Demonstrated ethical commitment to quality assurance and confidentiality of data and information.
Advanced communication and interpersonal skills, including the ability to obtain and interpret information appropriate to patients’ needs, ages, assessments, treatment, and care.
Ability to write clear, legible clinical notes and respond to correspondence independently as appropriate.
Experience working in highly confidential settings and ability to safeguard protected health information.
Excellent telephone, verbal, written, and interpersonal communication skills.
Ability to develop case management care plans and solutions using critical thinking and problem-solving skills.
Familiarity with computerized word processing and electronic medical records.
Ability to implement ideas and programs, work independently with minimal supervision, follow through on projects, and maintain attention to detail.
Creativity, flexibility, ability to work under stress, and ability to manage multiple interruptions.
Familiarity with disease processes, available resources, and treatment modalities, including assessment of their quality and appropriateness for specific conditions, disabilities, illnesses, and injuries.
Ability to provide age-appropriate care for pediatric, adolescent, adult, and geriatric patients based on principles of growth, development, and life stages.
Understanding of insurance policy language and healthcare options.
Ability to work in a team, facilitate family care conferences, communicate effectively with patients, and act as a patient advocate.
Ability to advocate for and respect patients’ and significant others’ rights.
Ability to use problem-solving techniques to resolve complaints or concerns and maintain cooperative relationships with staff and management.
Ability to communicate clearly, show respect for others, and attempt to resolve interpersonal conflicts.
Ability to develop and maintain collegial relationships with other professionals through continuing education and professional group sessions.
Must meet the listed experience requirement corresponding to the applicable nursing degree.

Nice To Haves

Bachelor or Master of Science in Nursing.
Strong clinical nursing skills with five years of hospital experience in varied clinical settings.
Knowledge of insurance carriers and Medicare guidelines in the hospital environment.
Knowledge of community health and social service resources.
Certification in Case Management from ACMA or CMSA.
Certified Medical Translator.
Bilingual skills.

Responsibilities

Apply and share knowledge of community health and social service resources.
Evaluate medical information and complete discharge needs assessments within one day of admission using established criteria to identify patients at high risk of requiring post-hospital services and case management or discharge planning intervention.
Initiate and complete safe inpatient discharge plans, arranging services such as Home Health, complex drug therapy interventions, outpatient clinic visits, skilled nursing, intermediate care, and assisted living.
Document the initial patient assessment and continually assess discharge needs throughout the continuum of care.
Work with external vendor partners to arrange post-discharge needs and maintain professional relationships with vendors.
Assess variables affecting health and functioning, interpret clinical information, and evaluate implications for treatment.
Issue Important Messages from Medicare (IMM), Medicare Outpatient Observation Notices (MOON), and denial of services letters in accordance with applicable health plan or Medicare guidelines.
Collaborate daily with Hospitalists and the multidisciplinary team to facilitate timely patient discharge.
Enter Avoidable Days and Code 44 documentation when appropriate.
Provide information about Advance Directives to patients and families when requested.
Respond to outpatient and community questions and referrals.
Screen medical records concurrently and/or retrospectively using established criteria for quality assurance and discharge planning.
Facilitate discharge planning throughout the continuum of care and appropriate placements or referrals for patients from neonate through geriatric populations.
Report suspected abuse, neglect, or unsafe discharge environments to the appropriate agency.
Develop and document individualized case management plans addressing physical, vocational, psychosocial, age, cultural, financial, and educational needs.
Coordinate appropriate services and resources and communicate with patients, families, significant others, and multidisciplinary team members regarding post-hospital needs.
Consult with social workers to identify appropriate social service needs.
Provide insurance carriers with information needed to authorize follow-up care and obtain pre-authorization for post-discharge services, including skilled nursing, durable medical equipment, home oxygen, and rehabilitation.
Relay pertinent information to the Case Management Manager for representation of Case Management on internal medical or quality committees and with inpatient nursing and ancillary provider staff, as appropriate.
Attend scheduled staff meetings, care conferences, and other appropriate meetings.
Attend Utilization Review Committee meetings as scheduling allows.
Share information from seminars and other educational sources with others as appropriate.