RN Case Manager - Southwest Medical Center - Days

INTEGRIS Health•Oklahoma City, OK

11h

About The Position

INTEGRIS Health Southwest Medical Center, Oklahoma's largest not-for-profit health system has a great opportunity for an RN Case Manager in Oklahoma City. In this position, you'll work full time, days with our Southwest team providing exceptional care to those who have entrusted INTEGRIS Heath with their healthcare needs. If our mission of partnering with people to live healthier lives speaks to you, apply today, and learn more about our increased compensation plans and recently enhanced benefits package for all eligible caregivers such as front-loaded PTO, 100% INTEGRIS Health paid short-term disability, increased retirement match, and paid family leave. We invite you to join us as we strive to be The Most Trusted Partner for Health. INTEGRIS Health Southwest Medical Center, Oklahoma’s largest not-for-profit health system has a great opportunity for an RN Case Manager in Oklahoma City, OK. In this position, you’ll work Monday - Friday 8a - 4p OR 4 - 10-hour shifts with our Southwest team providing exceptional care to those who have entrusted INTEGRIS Health with their healthcare needs. If our mission of partnering with people to live healthier lives speaks to you, apply today and learn more about our recently enhanced benefits package for all eligible caregivers such as, front loaded PTO, 100% INTEGRIS Health paid short term disability, increased retirement match, and paid family leave. The Case Manager is responsible for the clinical and financial outcomes for an assigned caseload of patients as appropriate. The Case Manager facilitates patient care during the hospitalization by managing, coordinating and monitoring resource utilization to achieve optimal clinical outcomes and financial goals. The Case Manager is responsible to proactively plan, coordinate and negotiate efficient patient movement throughout the continuum of care. In general, the Case Manager functions in the role of clinician, educator, researcher, manager and advocate to serve the best interests of the system and patient. Adheres to National Patient Safety Goals as appropriate based on the level of patient contact this position requires. INTEGRIS is an Equal Opportunity/Affirmative Action Employer. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

Requirements

5 years experience in a variety of clinical settings (e,g. home health, inpatient, physician office, clinic)
BLS (Basic Life Support) Issued by American Red Cross or American Heart Association within 30 days of hire
RN (Registered Nurse) Current licensure as a Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC)
Excellent interpersonal communication and collaboration skills
Computer experience
Must be able to communicate effectively in English (verbal/written).
This job requires the incumbents to operate a INTEGRIS-owned vehicle OR personal vehicle (non INTEGRIS-owned) and therefore must have a current Oklahoma State Drivers License as well as a driving record which is acceptable to our insurance carrier.

Nice To Haves

Experience with managed care and payer/provider requirements
Bachelor's of Science in Nursing
Case Management Certification

Responsibilities

Completes a comprehensive assessment of patients clinical, psychological and financial needs utilizing all available resources.
Recommends and coordinates timely transfers to appropriate levels of care as indicated by clinical needs and utilization criteria.
Develops, implements, evaluates and revises, as necessary, a plan for discharge, including referrals to other health care and community organizations based on needs assessment.
Communicates discharge care plan, and any changes in the plan to patient, family and all appropriate healthcare professionals.
Assists physicians and hospital staff in appropriate utilization of resources through application of utilization criteria and facilitating timely discharge planning for patients.
Coordinates services between hospital departments to facilitate timely patient discharge.
Conducts concurrent review of patient records on admission to the hospital and as determined by the patient's clinical condition.
Applies utilization criteria accurately in order to determine appropriate utilization of resources.
Notifies designated internal and external contacts of utilization issues that may affect patient care and/or reimbursement.
Facilitates patient transfers to other health care organizations in accordance with hospital policies and all-applicable state and federal guidelines and regulations.
Acts as a resource/advisor to physicians regarding discharge planning, medical record documentation, and all issues that may affect resource utilization and reimbursement.
Integrates and manages established pathways, where available, to enhance clinical effectiveness and clinical resource management.
Maintains knowledge and understanding of CMS regulations, Medicare/Medicaid, managed care and other payer regulations and benefit limits.
Acts as a resource and provides education for patients, their family members and all health care professionals regarding HCFA regulations, Medicare, Medicaid, managed care and other payers.
Develops and maintains knowledge and understanding of hospital and community resources, and facilitates use of most appropriate level of care to conserve patient, hospital, and payer resources.
Identifies opportunities to reduce cost of managing patient care without impacting quality or outcomes.
Participates in collecting and recording data for utilization and Quality Improvement reporting.
Works collaboratively and professionally with patients, family members, and physicians, hospital staff and other individuals and agencies involved in providing patient care.
Mental Health Only: Leads age and developmentally appropriate patient education and recreational groups to address the emotional, physical and environmental needs of Mental Health and/or Chemically Dependent patients.
Provides documentation daily in patients' charts on each group facilitated.
Facilitates discharge planning to assist patients in placement and treatment following discharge.
Participates in the development of patient plans of care to address goals of the patient (emotional, physical, spiritual, environmental) by attending treatment team meetings.
Participates in the writing of treatment plans with other program staff and physicians on hospital approved form.
Assists in utilization review process by contacting patients' insurance companies to provide clinical information to authorize patient treatment.
Serves as a patient advocate in the patients' needs, as well as those individuals involved with patients (as relevant).
Assists in the development and execution of marketing the program services to appropriate entities (outpatient therapists, primary care physicians, inpatient programs, etc.).
Completes or facilitates the completion of Emergency Detention paperwork, as well as ensure its distribution and receipt by legally designated individuals.
Provides physician ordered therapy in the areas of individual, family and marital sessions.
Develops and facilitates age and developmentally appropriate patient psychotherapeutic groups.
Is responsible for reviewing and noting physician orders.
Monitors patients' medications and provide education related to use and side effects.
Monitors vital signs as indicated by physician orders or if deemed medically necessary.
Assesses patients for appropriateness of admission to the program.
INTEGRIS Certified Case Management Only: Documents and communicates in a timely fashion patients progression throughout the continuum of care to all necessary parties via electronic, written, and verbal means.
Apprises team members of challenges encountered throughout the continuum of care via electronic, written, and verbal means.
Utilizing strong organizational skills, personally manage evolving calendar of commitments in the best interest of the patient and organization.
Utilizing excellent interpersonal, collaborative, and conflict resolution skills, act in the capacity of liaison between the patient, medical provider, and the organization to achieve positive outcome.
For INTEGRIS Decisions Only: Leads age and developmentally appropriate patient education groups to address the emotional, physical and environmental needs of Behavioral Health and/or Addiction Recovery patients.
Participates in the writing of treatment plans with other program staff and physicians.
Assist in utilization review process by contacting patients? insurance companies to provide clinical information to authorize patient treatment.
Serves as a patient advocate in the patients' needs, as well as those individuals involved with patient.
Completes or facilitates the completion of Emergency detention paperwork, as well as ensure its distribution and receipt by legally designated individuals.
Processes orders/refills or laboratory for ordering physician.
Monitors patient's medications and provide education related to use and side effects.
Monitors vital signs as indicated by physician orders or if deemed medically necessary.
Provides referrals options for patient's who are assessed, but do not enter the program.
Completes a comprehensive Initial Mental Health Assessment of patients clinical, psychological and financial needs utilizing all available resources.
Attends and participates in treatment team.