Clinical Resource Manager Case Manager

CLINICAL RESOURCE MANAGER / CASE MANAGER

Employment Type: Full time |
Shift: Day Shift

Provides hospital case management/utilization review and discharge planning collaboratively determining level of care needs beyond acute care, providing decision support to patients/families and physicians, managing patient and family expectations, and ensuring a smooth transition to the next level of care and services. Coordinates the integration of social services into patient care as appropriate. Coordinates the hospital activities concerned with case management/utilization review and discharge planning.

Adheres to departmental goals, objectives, standards of practice, and policies and procedures. Ensures quality patient care and adheres to regulatory compliance. Provides concurrent assistance and support to physicians and other clinical members of the health care team in coordinating the delivery of services for a select group of patients. To help achieve quality clinical and cost outcomes, incorporates real‑time contacts with physicians, nursing, and ancillary care givers to establish specific treatment, cost, and transition targets and to facilitate transition planning.

• RN license in Idaho or Oregon.
• Idaho only: if a nurse moves to Idaho from another compact state, apply for licensure by endorsement and update residence within 60 days of hire.
• All colleagues must provide licensure or proof of application for secondary state within 90 days of hire.
• BSN required; a master’s degree preferred.
• Minimum 2 years of varied hospital clinical experience.
• Experience in case management, home health, and/or the insurance industry preferred.

• Know, understand, incorporate, and demonstrate the organization’s mission, vision, and values in behaviors, practices, and decisions.
• Demonstrate knowledge and skills to care for all assigned age groups (neonate, child, adolescent, adult, geriatric as applicable).
• Revenue management: ensure accuracy of documenting services and supplies provided to patients.
• Coordinate integration of social services/case management into patient care, discharge, and home planning processes with other departments, external service organizations, agencies, and healthcare facilities.
• Complete screening/assessment of physician‑assigned cases to determine medical necessity/status determinations and transition needs.
• Conduct concurrent medical record review using established criteria to determine correct level of care for acute patients; assist physicians with completing transfer and discharge orders; maintain knowledge of federal, state, and private agency review requirements and regulations.
• Provide education to all health care team members including physicians regarding requirements to meet regulatory standards.
• Promote effective and efficient utilization of clinical resources from admission to discharge.
• Initiate and present denial letters as appropriate; complete PASRRs for admission to skilled nursing facilities; deliver Condition Code 44 letters to patients and educate them on Medicare benefits.
• Research and locate resources for patients (e.g., assistance in competing medication applications for financial assistance through pharmaceutical companies, work closely with Patient Financial Advocates in Medicaid pending process, and work closely with outside facilities to obtain equipment when patients have limited funding).
• Communicate with physicians at regular intervals throughout hospitalization and develop an effective working relationship; assist physicians to maintain appropriate cost, cases, and desired patient outcomes.
• Introduce self to patient and family and explain clinical resource manager role and the process for patient and family to contact the manager.
• Serve as a patient advocate; enhance a collaborative relationship to maximize patients’ and families’ ability to make informed decisions.
• Participate in multidisciplinary patient care rounds and/or conferences as appropriate to review treatment goals, optimize resource utilization, provide family education, and identify post‑hospital needs.
• Utilize physician advisor referral as appropriate.
• Follow department established process…