RN Case Manager

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well‑being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission.

EO/AA.

This position provides clinical case management services aimed at enhancing patient‑centered care and maximizing outcomes across the patient care continuum from pre‑admission through post‑discharge. Case management services include monitoring patient care to ensure progress toward desired outcome, addressing patient and family needs, resolving obstacles to effective care, coordinating care with payers and vendors, patients and families. Together with the multiple other internal team members the case manager is responsible for establishing, monitoring and executing patients' discharge plan.

This position may be required to access and administer medications within their scope of practice and according to State Law.

Corporate Overview:
The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

• Coordinates case management process from patient’s entry into the healthcare system to post‑discharge, including outpatient settings. Coordinates care and resources with physicians, social workers, and other team members to achieve optimal patient outcomes.
• Identifies patients who are suitable for case management intervention based on criteria such as cost, case complexity, frequency of admission or patient/family/provider or other healthcare team member request.
• Monitors and documents quality of care to ensure patient care plan goals are appropriate and that they are understood and implemented. Routinely assesses client and family response to services, while also measuring care plan effectiveness and necessity. Identifies patient needs, including those of an ethical and cultural nature, and ensures they are addressed.
• Facilitates cost‑effective outcomes by determining appropriate level of care based on diagnosis, severity, intensity of services required, and other relevant criteria, using national and regional length of stay standards and community norms.
• Assesses and discusses funding and insurance issues with client, family, and healthcare providers to enhance cost‑effective utilization of services and quality outcomes.
• Negotiates with third‑party payers relative to benefit levels, eligibility, utilization review, and reimbursement.
• Identifies actual and potential delays in service requests or treatment and communicates them to health care team so steps can be taken to eliminate or minimize delays.
• Works with other team members to plan appropriate and timely discharges.
• Establishes measurable discharge planning and self‑management goals that promote safe, cost‑effective, high‑quality outcomes.
• Provides oversight of issuance of CMS Important Message to patients.
• Supervises technical support staff assigned to individual case management teams.
• May set up patients' follow‑up appointments and performs post‑discharge phone calls to patients per care team design.
• May be required to complete home or site visits as required by the department.
• At the discretion of department operational and patient care needs, this position is required to work rotating schedules, which may include variable hours, weekends, nights, and holidays to meet the staffing and patient care demands of a 24/7 complex health system. Regular, reliable, and punctual attendance during assigned shifts is considered an essential function of the role.

• Ability to perform the essential functions of the job as outlined above.
• Demonstrated availability to work variable and rotating shifts, including nights, weekends, and…