Arbor Health, an equal-opportunity employer, offers competitive compensation and excellent benefits for our employees.
Arbor Health is committed to providing a drug-free work environment. Pre-employment substance abuse screening is required as a condition of employment.
Information regarding the Family and Medical Leave Act (FMLA) can be found here.
Email completed application to email@example.com or firstname.lastname@example.org
Case Management - (full-time)
Nursing and Nursing Administration
Under supervision of the Nurse Director, the Care Management RN coordinates and facilitates the discharge plan of care and service of selected patient populations across the continuum of illness, promote effective utilization and monitoring of health care resources, and assumes a leadership role with the interdisciplinary team to achieve optimal clinical, financial, and satisfaction of outcomes. Acts as intermediary between hospital and third-party payors to ensure patients receive appropriate medical services, and the organization receives appropriate and optimal reimbursement, in accordance with regulatory standards.
- Graduate of an accredited School of Nursing. BSN or MSN preferred. Required to obtain a BSN within three (3) years of start date.
- Current Washington state RN license.
- AHA (American Heart Association) BLS certification.
- One (1) year experience in utilization management/review/quality improvement preferred. Ideal candidate will have three years of clinical nursing experience in an acute care hospital or skilled nursing facility along with practical experience in case management, third party reimbursement, discharge planning and knowledge of DOH rules and regulations.
Primary job responsibilities:
- Reviews patient admission data within established timeframes of department, to determine the appropriate level of care in accordance with hospital-sanctioned industry standard criteria and/or other established criteria for other settings across the continuum of care.
- Assesses, develops, implements and monitors a comprehensive discharge plan of care through an interdisciplinary team process in conjunction with the patient and family in internal and external settings.
- Comprehensively assesses patients’ goals as well as their biophysical, psychosocial, environmental and discharge planning needs and financial status.
- Identifies key problems, strengths and resources to be addressed in the discharge plan of care, including needed resources post-discharge.
- Coordinates and facilitates discharge services.
- Ensures accurate documentation for patient’s continued hospital stay is established and maintained, coordinates necessary changes with attending physician and other team members as necessary to achieve optimal care and reimbursement.
- Communicates proactively and adeptly with members of the interdisciplinary team to ensure hospital and community resources are appropriately and effectively utilized on behalf of patients and their families.
- Facilitates interdisciplinary team meetings to improve quality, decrease cost and improve patient satisfaction.
- Coordinates documentation and clarifies necessary details with Patient Financial Services to assist in decreasing denials.
- Ensures the completion of documentation necessary for utilization assessments and communicates via electronic medical record information needed to justify continued hospitalization.
- Maintains any applicable care management databases.
- Performs concurrent review to determine correct admission status per insurance criteria, including Interqual or other industry standard criteria recognized by Medicare.
- Monitors and documents variance days, communicates with attending physician and UR Physician Advisor as indicated.
- Documents outcomes in appropriate locations.
- Communicates within designated time frames with third party payers in order to obtain authorizations and resolve payment issues on behalf of patients and families and the organization if applicable.
- Coordinates & facilitates Utilization Review Committee to CMS guidelines.
- May assume Palliative Care responsibilities as indicated, including facilitate and coordinate – pain and symptom management, POLST, family meetings, comfort care.
- Performs other duties as assigned.
Standard for portrayal of mission and values
- Employee demonstrates and fosters the Lewis County Hospital District No. 1 core values of - One team, on Mission. Go out of your way, to brighten someone's day. Own it, embrace it. Care like crazy. Motivate, elevate, appreciate. Know the way, show the way, ease the way. Find joy along the way.
- Employee demonstrates and fosters the mission of Lewis County Hospital District No. 1 to foster trust and nurture a healthy community.
- Is cooperative and supportive to others within the department and hospital providing care and services.
- Treats individuals including patients, co-workers, supervisors, management, patient families, physicians, volunteers, visitors and others with respect, dignity and fairness.
- Behaves professionally and ethically in all interactions with patients, co-workers, supervisors, management, patients' families, physicians volunteers, and others.
- Is consistently courteous to patients, co-workers, supervisors, management, patient’s families, physicians, volunteers and others; greets individuals and provides assistance and direction in an attentive and helpful manner.
- Willingly strives at continuous quality improvement to achieve quality work the first time every time.
- Is willing to learn new procedures and develop new skills for the purpose of improving quality of care and services.
- Willingly participates as a member of work team(s) supporting the goals and objectives of the department and the district.
- When answering the telephone, is courteous to caller, clearly identifies department, name and takes a message or directs calls as necessary in a helpful manner.
Open until filled