RN Case Manager - South Case Management

Join our team as a day shift and every other weekend, full time RN Case Manager, at INTEGRIS Southwest Medical Center, Oklahoma City, OK.

Join our team as a day shift and every other weekend, full time, RN Case Manager, at INTEGRIS Baptist Medical Center, Oklahoma City, OK.

Get to Know Your Team:

• INTEGRIS Health, Oklahoma’s largest not-for-profit health system, is seeking a dedicated caregiver to join us in our mission to partner with people to live healthier lives.
• Benefits of being an INTEGRIS Health caregiver include front-loaded PTO, medical benefits through the extensive INTEGRIS Health network, financial assistance for continued education, 24/7 mental health support and more.
• Take the first step toward growing your career by joining us.

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.

The RN Case Manager responsibilities include, but are not limited to, the following:

• 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…