RN Case Manager - Baptist Case Management

INTEGRIS Health•OK, OK

10h•Onsite

About The Position

INTEGRIS Health is seeking a full-time RN Case Manager for the Baptist Case Management team at INTEGRIS Baptist Medical Center in Oklahoma City, Oklahoma. The position is day shift and includes every other weekend. The RN Case Manager assesses patients’ clinical, psychological, and financial needs; coordinates appropriate levels of care and discharge planning; supports appropriate utilization of resources; and collaborates with patients, families, physicians, hospital staff, and community organizations. The role also includes patient and provider education, monitoring payer and regulatory requirements, facilitating transfers, and participating in utilization and Quality Improvement reporting.

Requirements

At least 2 years of experience in a clinical setting, such as home health, inpatient care, a physician office, or a clinic.
Current Registered Nurse (RN) license in Oklahoma or a current multistate license from a Nurse Licensure Compact (eNLC) member state.
BLS (Basic Life Support) certification issued by the American Red Cross or American Heart Association within 30 days of hire.
Excellent interpersonal communication and collaboration skills.
Computer experience.
Ability to communicate effectively in English, verbally and in writing.
Current Oklahoma State Driver’s License and a driving record acceptable to the employer’s insurance carrier, as the role requires operating an INTEGRIS-owned or personal vehicle.

Nice To Haves

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

Responsibilities

Complete comprehensive assessments of patients’ clinical, psychological, and financial needs using available resources.
Recommend and coordinate timely transfers to appropriate levels of care based on clinical needs and utilization criteria.
Develop, implement, evaluate, and revise discharge plans, including referrals to health care and community organizations based on assessed needs.
Communicate discharge plans and changes to patients, families, and appropriate health care professionals.
Assist physicians and hospital staff with resource utilization by applying utilization criteria and facilitating timely discharge planning.
Coordinate services between hospital departments to support timely patient discharge.
Conduct concurrent reviews of patient records upon admission and as determined by the patient’s clinical condition.
Apply utilization criteria accurately to determine appropriate use of resources.
Notify designated internal and external contacts of utilization issues that may affect patient care or reimbursement.
Facilitate patient transfers to other health care organizations in accordance with hospital policies and applicable state and federal guidelines and regulations.
Advise physicians on discharge planning, medical record documentation, resource utilization, and reimbursement issues.
Integrate and manage established pathways where available to enhance clinical effectiveness and resource management.
Maintain knowledge of CMS, Medicare/Medicaid, managed care, and other payer regulations and benefit limits.
Educate patients, family members, and health care professionals about HCFA regulations and Medicare, Medicaid, managed care, and other payers.
Maintain knowledge of hospital and community resources and facilitate use of the most appropriate level of care.
Identify opportunities to reduce the cost of managing patient care without affecting quality or outcomes.
Participate in collecting and recording data for utilization and Quality Improvement reporting.
Work collaboratively and professionally with patients, families, physicians, hospital staff, and other individuals and agencies involved in patient care.