RN Case Manager - Resource Management

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POSITION SUMMARY:

Coordinates the care needs of patients with complex medical concerns across the continuum of care.

• Assesses the patient’s formal and informal support systems and needs.
• Assists patients in coordinating and gaining access to needed medical, psychiatric, social, educational, psychosocial, and other services.
• Develops, implements, monitors, and modifies a discharge plan of care (across the continuum) through an interdisciplinary and collaborative team process, in conjunction with the patient and his/her caregiver.
• Assumes the basic responsibility for coordinating the continuity of care for patients as they move between home and another facility/setting where care is provided.
• Links the patient with the most appropriate institutional or community resources. Advocates on behalf of the patient for scarce resources, and develops new resources if gaps exist in the service continuum.
• Brokers with third party payers, when appropriate, to obtain needed services to assist patients in achieving outcomes.
• Monitors the plan to ensure the quality, quantity, timeliness, and effectiveness of services; provides periodic reassessment to assure that services are appropriate, cost-effective, and not increasing the patient’s dependency.
• Evaluates the patient and outcomes to determine whether the patient should be continued in Case Management or case closed.
• Maintains a current record of services to the patient in the medical record in accordance with departmental standards.
• Identifies and maintains up-to-date information on community resources and uses appropriate referrals.
• Communicates clearly, accurately, and in a timely manner with physicians and other appropriate personnel regarding patient status and progress.
• Coordinates inter-facility transfers; keeps current on COBRA regulations.
• Submits departmental statistical reports within stated deadlines.

Required
: 5 years of professional nursing experience; prior RN experience in acute care setting; competent clinical judgments and leadership ability; excellent communication skills in all areas: oral, written, and by telephone; ability for problem solving, decision making, and establishing effective rapport with personnel, patients, families, physicians, and colleagues; knowledge of disease classifications and current standards of practice; knowledge of federal and state regulations;

and awareness of managed care concepts and payer authorization criteria.

Preferred
: BSN;
Case Management experience; CCM or CPUM certification; and Bi-lingual.

Lic/Reg/Cert
:
Current Oregon RN License.

Light physical demand capabilities and advanced cognitive skills necessary to perform essential job functions. Able to get to all nursing units in the hospital. Able to prioritize work demands and organize time efficiently. Able to read medical charts and discern written information. Able to work independently and with others. Able to make appropriate judgments and support decisions even in stressful situations.

• Assesses the patient’s formal and informal support systems and needs.
• Assists patients in coordinating and gaining access to needed medical, psychiatric, social, educational, psychosocial, and other services.
• Develops, implements, monitors, and modifies a discharge plan of care (across the continuum) through an interdisciplinary and collaborative team process, in conjunction with the patient and his/her caregiver.
• Assumes the basic responsibility for coordinating the continuity of care for patients as they move between home and another facility/setting where care is provided.
• Links the patient with the most appropriate institutional or community resources. Advocates on behalf of the patient for scarce resources, and develops new resources if gaps exist in the service continuum.
• Brokers with third party payers, when appropriate, to obtain needed services to assist patients in achieving…