RN Care Management

PeaceHealth•Longview, WA

3d•Onsite

About The Position

The RN Care Management position is with the Care Management team at St. John Medical Center in Longview, Washington. This is a 1.0 FTE day-shift role working 8-hour shifts. The RN coordinates and facilitates discharge plans and services for selected patient populations across the continuum of illness, promotes effective use and monitoring of health care resources, and leads interdisciplinary collaboration to achieve optimal clinical, financial, and patient-satisfaction outcomes. The RN serves as an intermediary between the hospital and third-party payors to support appropriate medical services and reimbursement in accordance with regulatory standards. The role reviews admissions and determines appropriate levels of care using established criteria; assesses patient goals and biophysical, psychosocial, environmental, discharge-planning, and financial needs; and develops, implements, and monitors comprehensive discharge plans with patients, families, and interdisciplinary teams. The RN coordinates necessary services and documentation, supports utilization review and authorization processes, maintains applicable databases, and may take on palliative care responsibilities as indicated. The job requires an accredited nursing education, at least three years of clinical nursing experience in an acute care hospital (with certain equivalent experience potentially considered), Washington RN licensure by the date of hire, and BLS certification by the date of hire. The position involves patient handling and other physical activity, exposure to biohazards and body fluids, and work in a noisy environment.

Requirements

Graduate of an accredited school of nursing.
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.
Current Washington Registered Nurse licensure required by date of hire.
Current BLS (Basic Life Support) certification required at date of hire.
Demonstrated ability to promote positive interpersonal relationships and a patient- and family-centered work environment.
Basic computer skills, including MS Office applications.
Effective prioritization skills.
Interpersonal skills to obtain and interpret information appropriate to patients’ needs and age for assessment, treatment range, and patient care.
Ability to perform the stated physical tasks, including patient handling, pushing and pulling, CPR, frequent movement and positioning, and lifting.
Ability to work around biohazards, body fluids, airborne particles, and noise.
Vision and hearing within normal limits; glasses, contacts, and hearing aids are permitted.
Ability to communicate and exchange accurate information.

Nice To Haves

Utilization management or quality management experience.
Skill and proficiency in applying highly technical principles, concepts, and techniques, usually acquired through a bachelor’s degree in nursing; an equivalent combination of education, training, and experience that fulfills position requirements will be considered.
Knowledge of third-party reimbursement.

Responsibilities

Coordinate and facilitate discharge plans and services for selected patient populations across the continuum of illness.
Promote effective utilization and monitoring of health care resources and lead interdisciplinary work toward optimal clinical, financial, and satisfaction outcomes.
Act as an intermediary between the hospital and third-party payors to support appropriate services and reimbursement in accordance with regulatory standards.
Review patient admission data within department timeframes and determine appropriate levels of care using established criteria.
Assess patients’ goals, biophysical, psychosocial, environmental, discharge-planning, and financial needs.
Identify problems, strengths, and resources relevant to discharge planning, including post-discharge resources, and coordinate needed services.
Develop, implement, and monitor comprehensive discharge plans through interdisciplinary processes with patients and families in internal and external settings.
Ensure accurate documentation for continued hospital stays and coordinate necessary changes with attending physicians and other team members.
Communicate with interdisciplinary team members to ensure hospital and community resources are appropriately and effectively used.
Facilitate interdisciplinary team meetings to improve quality, decrease cost, and improve patient satisfaction.
Coordinate documentation and clarify details with Patient Financial Services to help decrease denials.
Ensure completion of utilization assessment documentation and communicate information needed to justify continued hospitalization through the electronic medical record.
Maintain applicable care management databases.
Perform concurrent review to determine correct admission status according to insurance criteria, including InterQual or other Medicare-recognized industry-standard criteria.
Monitor and document variance days, communicate with attending physicians and the UR Physician Advisor as indicated, and document outcomes in appropriate locations.
Communicate with third-party payors within designated timeframes to obtain authorizations and resolve payment issues for patients, families, and the organization, as applicable.
May facilitate and coordinate palliative care responsibilities, including pain and symptom management, POLST, family meetings, and comfort care.
Perform other duties as assigned.

Benefits

Full benefits package effective the first of the month following start date.
Relocation assistance.
Full medical, dental, and vision coverage.
403(b) retirement plan with employer base and matching contributions.
Paid time off.
Employer-paid life and disability insurance, with additional buy-up coverage options.
Tuition and continuing education reimbursement.
Wellness benefits.
Expanded EAP and mental health program.
Competitive and comprehensive total rewards package supporting caregivers’ physical, emotional, financial, social, and spiritual wellbeing.