Registered Nurse (RN) Educator Case Management (FT M-F plus call)

UMC Health System

1d•Onsite

About The Position

This position provides education to Case Management staff regarding acute case management. This position is responsible for assessing and coordinating patient care, utilizing accepted criteria and guidelines to manage benefits and determine medical necessity of services provided. This position will function as a clinician, case manager, and educator to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization.

Requirements

Graduation from an accredited school of nursing.
Current valid License as a Registered Nurse through the Texas Board of Nursing.
CPR/First Aid Certificate required.

Nice To Haves

A minimum of two years in case management inpatient and outpatient preferred.
A minimum of two years of experience in utilization review preferred.
A minimum of five years experience preferred in managed care setting, inpatient, and outpatient setting preferred.
A minimum of two years in a leadership, coordinator, and/or educator position preferred.
ACM or CCM preferred.

Responsibilities

Review and manage utilization review cases.
Serves as coverage for case managers for utilization review, coordination of care, and readmissions.
Lead new projects, run reports, and collaborate to meet project goals.
Educate the department on new CMS rules.
Responsible for Initial Assessment for potential patient in the setting Home- Visits to support environmental and physical assessments).
Responsible for leading both inpatient and outpatient case managers to fulfilling job expectations.
Acts as a liaison between the patients and interdisciplinary team members.
Provides case management staff education on chronic disease and management across the continuum.
Responsible for staff scheduling and new hire training.
Develops up-to-date education materials to case management and patients.
Troubleshoots issues with case managers, social workers, providers, and case management directors.
Functions as patient advocate.
Ensures the implementation and compliance of patient care.
Collaborates and supports and reports policies and procedures as necessary for UMC.
Participates as an active member of the case management team.
Collaborates and coordinates to ensure efficient operations i.e. staffing.
Maintains acceptable standards of case management nursing care, based on ACMA and CMS guidelines, as well as DNV standards.
Assists with preparing for various audits.
Assumes the role of supervisor, nursing in his/her absence and assists in completing subordinate’s performance evaluations as/if needed.
Incorporates innovative, research-based practice into the current case management model.
Performs other related duties as assigned by case management director and/or administrative team.
Leads meetings with various UMC departments to implement new processes approved by case management director.