RN Case Manager

Kootenai Health • Cda, ID

84d

About The Position

The RN Case Manager functions as a resource and advocate on behalf of the patient and family while assisting in the navigation of the health care delivery continuum by operationalizing multiple processes. Coordinates hospital transitions to the next level of care, including, but not limited to, medical community partners, Kootenai Care Network, and ambulatory clinic care coordinators.

Requirements

• State of Idaho Registered Nurse or licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the 'multistate privilege to practice' compact with Idaho
• Licensed RN with a minimum 3 years' patient-facing RN experience at time of hire, ADN or diploma required; BSN or higher preferred.
• Licensed RN's with less than 3 years' patient-facing RN experience as an ADN at time of hire are required to be enrolled in a baccalaureate (or higher) degree program in nursing within 1 year of employment, with BSN completion within 3 years of hire
• Minimum 3 years clinical practice experience required
• Previous utilization review experience preferred
• Current Certified Case Manager (CCM) certification, American Case Management (ACMA) certification, Certified Professional Utilization Review (CPUR) or Case Management Administration Certification (CMAC) preferred
• Excellent communication, organizational and interpersonal skills. Ability to work independently and manage time and decisions
• Proficiency with standard software applications including spreadsheets and word processing required. Experience using Interqual preferred
• Knowledge of healthcare law and regulations related to acute care and the immediate post-acute continuum preferred

Responsibilities

• Participates in utilization management, discharge planning, patient throughput, and evaluates the appropriate use of hospital resources by ensuring that patients meet medical necessity during their hospitalization
• Utilizes the organizational approved references and software programs to assess medical necessity
• Responsible for managing payer relations and requirements to achieve optimum reimbursement and patient outcomes
• Reviews documentation for quality assurance and clinical validation
• Ensures CMS discharge standards are achieved
• Provides case management in collaboration with the medical staff, nursing, and ancillary departments throughout the hospital to ensure a safe, timely, transition to the appropriate level of care
• Familiar with standard concepts, practices, and procedures within the field
• Relies on experience and judgment to plan and accomplish goals
• Regular and predictable attendance is an essential job function
• Competent to meet age specific needs of the unit assigned

Benefits

• Opportunities for learning, growing, and advancing within the organization
• Personalized service from Internal Recruiters for career transitions
• Support for career pathways and skill development

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees