RN Case Manager

Baptist Health•Homewood, AL

About The Position

The RN Case Manager promotes and facilitates effective use of hospital resources. The role assists with planning a comprehensive, individualized case management plan that addresses patient and family needs and supports transition to the next appropriate level of care. The position works collaboratively across the care team to support optimal patient outcomes, coordinate care, and manage utilization and length of stay.

Requirements

For team members hired into this job before January 1, 2020: completion of an accredited RN education or training program.
Bachelor of Science in Nursing (BSN) degree within 36 months of placement.
Three years of experience in chronic disease management, case management, utilization management, or acute clinical care.
Maintain an RN license in the State of Alabama.
Maintain current BLS/healthcare provider certification.

Responsibilities

Initially and concurrently assess patients in the assigned population, including diagnosis and medical history, current treatment, age, payment source, criteria compliance, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, and special or personal needs.
Assign working DRG and GMLOS and monitor and manage length of stay as appropriate, using medical necessity determined through InterQual guidelines.
Develop collaborative relationships with patients and families, patient business, nursing staff and leadership, physicians, social workers, care coordinators, and ancillary services to facilitate optimal outcomes and efficient movement through the continuum of care.
Prioritize activities in assigned areas, focusing on high-risk, high-cost, and problem-prone cases.
Advocate for patients' health care needs.
Perform admission and concurrent utilization review in compliance with managed care contracts, governmental payors, and departmental review policies, and adhere to the Utilization Management Plan.
Communicate appropriately and promptly with the interdisciplinary team to coordinate and evaluate the plan of care.
Communicate with third-party payers and external care teams as appropriate or necessary.
Monitor and evaluate data, fiscal outcomes, and other relevant information to develop and implement process-improvement strategies for case management activities.
Maintain positive relationships with peers, the collaborative team, outside reviewers, and post-acute providers.
Maintain reasonably regular and punctual attendance consistent with Baptist Health policies and applicable laws and standards.
Comply with Baptist Health policies and procedures.

Benefits

Medical, dental, and vision benefits.
403(b) retirement savings plan with matching.
Health Savings Account (HSA).
Flexible Spending Account (FSA).
Paid time off, up to five weeks to start.
Life insurance.
Extended Leave Plan (ELP).
Family Care for childcare, elder care, and pet care.
Educational benefits, including tuition reimbursement and monthly payments to help pay down graduated school debt.
Benefits start on day one.