RN Case Manager - Days

Integris Health•Woodward, OK

46d

About The Position

INTEGRIS Health, Oklahoma's largest not-for-profit health system has a great opportunity for a RN Case Manager in Woodward, OK. In this position, you'll work Full Time 7:30am-4:00pm with our Case Management 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 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. 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) required.
Current licensure as a Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state.
Excellent interpersonal communication and collaboration skills.
Computer experience required. Windows preferred.
Current Driver's License issued by the state of Oklahoma.

Nice To Haves

Experience with managed care and payer/provider requirements preferred.
BSN preferred.
Current Case Management Certification preferred, at minimum attained within one year of hire (INTEGRIS Certified Case Management only)

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.
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.
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.
Assist in utilization review process by contacting patients? insurance companies to provide clinical information to authorize patient treatment.
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.