RN Acute Case Manager - System Care Management - Full Time Day

Guthrie Careers-posted 4 months ago

$37 - $53/Yr

Full-time • Mid Level

Binghamton, CA

Resume

Match Score

Upload and Match ResumeTrack Jobs with Teal

The Acute Case Manager utilizes industry accepted processes for achieving optimal patient, clinical, and operational outcomes timely, coordinated, and in cost effective manners. The Acute Case Manager has the responsibility, accountability, and authority for coordinating the medical management of hospital patients, using outcomes-based approaches. The Acute Case Manager supports the healthcare team in assessing, planning, and facilitating individualized continuum of care plan for patients, based on assessed needs and available resources. The Acute Case Manager monitors clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal and external offices, payors, and providers. The Acute Case Manager collaborates cooperatively with the patient and members of the interdisciplinary health care team. The Acute Case Manager takes a proactive approach to ensuring the integration of both clinical and operational outcomes through analysis of clinical and financial data, including length of stay and DRG profiling.

Collaborates to support that the right care is provided to patients in the right setting with a broad spectrum of health and community providers.
Works closely with the Medical Director and other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria.
Educates the physician and other healthcare team members regarding the coordination of care processes of the patient across the continuum of care.
Participates in an on‐call system to ensure 24‐hour accessibility and accountability to meet patient needs.
Serves as patient advocate in representing the patient’s best interests to the providers.
Procures insurance authorizations where indicated to ensure appropriate, cost effective care.
Acts as an institutional advocate by managing care in a cost-effective manner and communicating with third party payers.
Coordinates medical management through ongoing interaction with the patient and family/caregivers, physician and other health care providers to achieve designated clinical, operational and financial outcomes.
Facilitates clinically appropriate treatment and coordinates flow of services by acting as a focal point for communication for healthcare team members, patient, provider, and payer.
Maintains accountability for coordination of care processes for the patient during the acute care phase, and during the transition phase to outpatient services.
Initiates and participates in patient care conferences as appropriate.
Completes nursing assessment forms in the system.
Addresses PRI and other referral procedures as needed for continuing care needs.
Provides leadership for clinical staff regarding complex patient care concerns and/or care of patients who do not achieve expected outcomes.
Identifies individual patient discharge needs in collaboration with other clinical team members beginning upon initial admission assessment and continued reassessment throughout an episode of care.
Assists in the implementation of discharge planning as necessary, through concurrent monitoring and reevaluation, to accommodate changes in treatment or progress.
Ensures patient understanding of rights, choices, and consequences.
Completes referral procedures to the appropriate institutional, community, or specialized resources.
Integrates patient information, clinical/financial/operational data and evaluates the impact upon patient, clinical, and financial outcomes.
Identifies opportunities to continue or reduce costs and optimize case reimbursement.
Maintains compliance with documentation requirements and guidelines of third-party payers, regulatory and government agencies.
Participates in long‐range planning to meet the needs high risk patients and/or population.
Demonstrates leadership skills including effective written and verbal communication, conflict resolution, problem solving and critical thinking, organizational and time management skills and appropriate delegation.
Develops and promotes collaborative relationships with other members of the Guthrie Healthcare System Enterprise and community resources, including home health agencies, DME companies, nursing homes, etc.
Maintains a positive and professional relationship with payers that supports continued managed care contracts.
Articulates the primary objectives of Care Coordination processes to all members of the health care/leadership team and others as necessary.
Participates in performance improvement and educational activities.
Incorporates available current evidence-based data for clinical care management.
Demonstrates knowledge of federal, state and system regulations and aligns practice to comply with such.
Serves as an educational resource for other members of the healthcare team in regards to changes in reimbursement and /or utilization requirements.
Maintains 8 hours of continuing education per year.
Contributes to Performance Improvement (PI) activities through both individual and aggregate data monitoring.
Validates authorization/certification process for elective short procedures and urgent inpatient care services in collaboration with physician offices and other hospital departments as appropriate.

RN Bachelor of Science degree in Nursing (BSN) or a Bachelor of Arts (BA) degree in addition to a degree in Nursing.
A registered nurse with five (5) years relevant experience willing to pursue a BSN or BA degree will be considered.
Must obtain BSN within two (2) years of hire.
Demonstrated leadership skills for a licensed degree exception, there must be a significant depth of clinical experience: five (5) years of experience in an acute care setting with strong care management, utilization review, and payer knowledge.
A Case Management certification or obtaining a Case Management certification within one (1) year of eligibility is encouraged.

Up To $25,000 Sign On Bonus
Pay range of $37.50 - $53.06 per hour

Track Jobs with Teal

Job Search Resources

•

Resume Builder

•

RN Case Manager Resume Examples

•

Cover Letter Examples

RN Acute Case Manager - System Care Management - Full Time Day

Job Search Resources

Tools

Career Hubs

Guides

Company