RN, Care Management

Oregon Health & Science University • Portland, OR

19h • Onsite

About The Position

The Care Management department provides several major services to assure safe and efficient throughput of patients during their acute hospitalization and transition to the next level of care. Our goal is to balance individual clinical and psychosocial patient/family needs with the efficient and cost-effective utilization of resources while promoting quality outcomes. RN case managers assess patients on admission for available family support, insurance resources, and potential discharge planning needs. They engage in daily multidisciplinary rounds Monday through Friday to develop and implement patient discharge plans with input from various other disciplines. The RN case manager is responsible for coordinating post-acute and discharge needs in a timely and cost-efficient manner. Using established criteria to determine appropriateness of continued hospital stay, RN case managers work with payors on obtaining needed authorizations for ongoing hospitalization and/or identified post-acute needs. The RN Case Manager collaborates with the patient and family, members of the multidisciplinary team, community resources and agencies, and payors to ensure the patient’s progress and level of care is appropriately determined. Intensity of service is dependent on individual patient needs as assessed by the case manager. RN case managers practice robust utilization and resource management. RN case managers also frequently lead multidisciplinary and family care conferences involving complex care situations. They contribute to meeting OHSU’s strategic plan of safe length of stay reduction and reduction in readmission rates. Case Management is represented on every adult and pediatric unit and in the Emergency department. Each Case Manager has an office with a workstation near the unit they are assigned to. Communication factors: Case Managers are available by pagers, telephone/voicemail, Microsoft Teams, Epic Secure Chat, and e-mail.

Requirements

• Minimum three (3) years of clinical nursing experience in the last 7 years.
• Minimum two (2) years of Inpatient Case/Care Management experience in the last 5 years.
• Baccalaureate Degree in Nursing from a program accredited by Commission of Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN) or Commission for Nursing Education Accreditation (CNEA) 30 days before start date (for BSN Graduates).
• Associate Degree in Nursing from an accredited program 30 days before the start date (for ADN Graduates).
• Associate degree Nurses required to enroll in BSN program within 3 years of hire and complete within 5 years of hire.
• Current, unencunbered Oregon State Registered Nurse License.
• BLS from AHA required. New hires will be enrolled and required to complete during orientation.
• Must be able to perform the essential functions of the position with or without accommodation.

Nice To Haves

• Case Management Certification (ACMA, RN-BC, CMSA)
• Hospital based case management experience.
• Proficiency with managing difficult and sensitive family and provider care conferences including: adjustment to new levels of function, end of life discussions, imbalance of available resources (social, spiritual, medical, financial).
• Progressive leadership positions within a nursing unit, examples include: Charge nurse, UBNPC Chair/Member, Shared Governance councils.

Responsibilities

• Assess patients on admission for available family support, insurance resources, and potential discharge planning needs.
• Engage in daily multidisciplinary rounds Monday through Friday to develop and implement patient discharge plans with input from various other disciplines.
• Coordinate post-acute and discharge needs in a timely and cost-efficient manner.
• Work with payors on obtaining needed authorizations for ongoing hospitalization and/or identified post-acute needs.
• Collaborate with the patient and family, members of the multidisciplinary team, community resources and agencies, and payors to ensure the patient’s progress and level of care is appropriately determined.
• Practice robust utilization and resource management.
• Lead multidisciplinary and family care conferences involving complex care situations.
• Contribute to meeting OHSU’s strategic plan of safe length of stay reduction and reduction in readmission rates.
• Using approved criteria, conduct a comprehensive patient/family assessment and admission clinical review upon admission to the emergency department to ensure appropriateness of the care setting.
• Provide early identification of high-risk patients and their needs.
• Perform care coordination and discharge planning for patients in the Emergency department and Observation units.
• Assess patients’ potential to discharge from the emergency department with community care coordination.
• Round with Advance Practice Providers at designated times BID.
• Assist the transfer center with coordinating appropriate patient transfers out of the emergency department.
• Educate providers regarding documentation requirements that support medical necessity determinations.
• Deliver Medicare notifications including but limited to: Condition Code 44 notices, Observation notices, and Medicare Important Messages.
• Document according to departmental policy.
• Lead the effort to ensure compliance with CMS and other insurance regulations related to Care Management.
• Provide nurse case management support to patients, families, and staff in both the inpatient and emergency department settings for the evening shift 7 days per week.
• Receive referrals and hand offs from day shift case managers.
• Complete hand off of information to day shift case managers.
• Troubleshoot and resolve any discharge delays or barriers carrying over into evening shift.
• Be aware of and comply with regulatory requirements of DNV, Medicaid, Medicare, and Oregon Nurse Practice Act.

Benefits

• Comprehensive health care plans. Covered at 100% of the cost for full-time employees and 88% for dependents.
• $50K of term life insurance provided at no cost to the employee.
• Two separate above market pension plans to choose from.
• Vacation - 192 to 288 hours per year depending on length of service, prorated for part-time.
• Holidays - up to 64 holiday hours per calendar year (employees accrue .0308 holiday hours for each hour paid – included in vacation accruals).
• Sick Leave - 96 hours per year, prorated for part-time.
• Substantial public transportation discounts (Tri-met and C-Tran).
• Tuition Reimbursement.
• Innovative Employee Assistance Program (EAP) including extensive wellness resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree