RN Case Manager Utilization Review - Care Coordination

Location Address:

1100 Central Avenue SE , Albuquerque, New Mexico , United States of America

Compensation Pay Range:

Minimum Offer $:

34.68

Maximum Offer for this position is up to $:

52.95

Summary:

Make a difference. Presbyterian is hiring an RN Case Manager with Care Coordination. The Case Manager provides clinically-based case management to support the delivery of effective and efficient patient care. The role integrates utilization management, care coordination, and transition planning functions. The Case Manager IV has the overall accountability for a designated case load and plans effectively in order to meet patients needs, manage the length of stay, and promote efficient utilization of resources.

In collaboration with the interdisciplinary team, the case manager IV supports the physician in facilitating patient care with the objective of enhancing the quality of patient outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers.

Sign on and relocation bonuses available for qualified candidates.

How you grow, learn and thrive matters here.

• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities

• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)

• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)

• Malpractice liability insurance

• Loan forgiveness through the New Mexico Higher Education Department

• EPIC electronic charting system

Type of Opportunity:

PRN

FTE:

0

Job Exempt:

No

Work Shift:

Varied Days and Hours (United States of America)

Job Description:

• Interviews and assesses each patient, family or other designated person(s) within 48 hours of admission in order to obtain financial, emotional, physical, social, functional and health care needs in order to define and recommend potential discharge plans, manage patient and family expectations, identify readmission risk and target interventions to reduce risk for readmission, and identify, adjust and manage barriers to discharge.
• Applies approved clinical criteria to monitor appropriateness of admissions and continued stays to ensure a clear status determination. Refers cases and issues to Case Management Medical Director based on departmental standards.
• Demonstrates skill in communicating with physicians the necessary
• Documentation required to demonstrate medical necessity. Elevates to Supervisor and/or Medical Director all patients not meeting criteria after discussion with physician.
• Demonstrates skill in educating patient, family and interdisciplinary team regarding post-acute care options, status determination, and other care coordination services.
• Develops implements, coordinates, monitors and evaluates preliminary and final discharge plans with the interdisciplinary team, patient and family. Arranges and/or facilitates identified discharge needs and services of patients and ensures timely intervention to prevent delays in service and transition of care. Ensures all elements of the plan of care have been communicated to the patient/family and members of the healthcare team to assure continuity of care.
• Participates and facilitates care progression in daily multidisciplinary rounds and addresses target length of stay with health care providers to achieve complete delivery of services within prescribed timeframe. Monitors length of stay and takes action to mitigate over utilization and elevates to medical director as needed.
• Presents and actively participates in complex rounds, discharge planning huddles, process improvement teams, department specific initiatives and department meetings.
• Identifies patients and families with complex psychosocial issues and refers them to the Social Worker as appropriate. Demonstrates skill and success in collaboration with Social Work partner.
• Facilitates and leads patient/family and provider care conferences as needed.
• Documents results of assessments, status assignment, and interventions and discharge planning in the medical record according to departmental policies…