RN Case Manager - Baptist Medical Center - Days

INTEGRIS Health•Oklahoma City, OK

19h•Onsite

About The Position

INTEGRIS Health Baptist Medical Center, Oklahoma’s largest not-for-profit health system, is seeking an RN Case Manager in Oklahoma City, OK. This full-time day position is with the Baptist Case Management team, providing exceptional care to patients. The Case Manager is responsible for the clinical and financial outcomes for an assigned caseload of patients, facilitating patient care during hospitalization by managing, coordinating, and monitoring resource utilization to achieve optimal clinical outcomes and financial goals. The role involves proactively planning, coordinating, and negotiating efficient patient movement throughout the continuum of care, functioning as a clinician, educator, researcher, manager, and advocate. The position also requires adherence to National Patient Safety Goals.

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
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
Must be able to communicate effectively in English (verbal/written)
Current Oklahoma State Drivers License
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.
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 (Mental Health Only).
Provides documentation daily in patients' charts on each group facilitated (Mental Health Only).
Facilitates discharge planning to assist patients in placement and treatment following discharge (Mental Health Only).
Participates in the development of patient plans of care to address goals of the patient (emotional, physical, spiritual, environmental) by attending treatment team meetings (Mental Health Only).
Participates in the writing of treatment plans with other program staff and physicians on hospital approved form (Mental Health Only).
Assists in utilization review process by contacting patients' insurance companies to provide clinical information to authorize patient treatment (Mental Health Only).
Serves as a patient advocate in the patients' needs, as well as those individuals involved with patients (as relevant) (Mental Health Only).
Assists in the development and execution of marketing the program services to appropriate entities (outpatient therapists, primary care physicians, inpatient programs, etc.) (Mental Health Only).
Completes or facilitates the completion of Emergency Detention paperwork, as well as ensure its distribution and receipt by legally designated individuals (Mental Health Only).
Provides physician ordered therapy in the areas of individual, family and marital sessions (Mental Health Only).
Develops and facilitates age and developmentally appropriate patient psychotherapeutic groups (Mental Health Only).
Is responsible for reviewing and noting physician orders (Mental Health Only).
Monitors patients' medications and provide education related to use and side effects (Mental Health Only).
Monitors vital signs as indicated by physician orders or if deemed medically necessary (Mental Health Only).
Assesses patients for appropriateness of admission to the program (Mental Health 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 (INTEGRIS Certified Case Management Only).
Apprises team members of challenges encountered throughout the continuum of care via electronic, written, and verbal means (INTEGRIS Certified Case Management Only).
Utilizing strong organizational skills, personally manage evolving calendar of commitments in the best interest of the patient and organization (INTEGRIS Certified Case Management Only).
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 (INTEGRIS Certified Case Management 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 (For INTEGRIS Decisions Only).
Participates in the writing of treatment plans with other program staff and physicians (For INTEGRIS Decisions Only).
Assist in utilization review process by contacting patients? insurance companies to provide clinical information to authorize patient treatment (For INTEGRIS Decisions Only).
Serves as a patient advocate in the patients' needs, as well as those individuals involved with patient (For INTEGRIS Decisions Only).
Completes or facilitates the completion of Emergency detention paperwork, as well as ensure its distribution and receipt by legally designated individuals (For INTEGRIS Decisions Only).
Processes orders/refills or laboratory for ordering physician (For INTEGRIS Decisions Only).
Monitors patient's medications and provide education related to use and side effects (For INTEGRIS Decisions Only).
Monitors vital signs as indicated by physician orders or if deemed medically necessary (For INTEGRIS Decisions Only).
Provides referrals options for patient's who are assessed, but do not enter the program (For INTEGRIS Decisions Only).
Completes a comprehensive Initial Mental Health Assessment of patients clinical, psychological and financial needs utilizing all available resources (For INTEGRIS Decisions Only).
Attends and participates in treatment team (For INTEGRIS Decisions Only).
Meets established deadlines.
Attends required inservices.
Maintains staff competencies.
Completes required documentation.
Collaborates and works as a team player with all disciplines.
Presents a professional image to all customers and patients.