Nurse (RN) Case Manager

San Carlos Apache Healthcare Corporation; Peridot (AZ); On-site; USD 65,000 - 85,000; Full time

Job summary

Entertimeonline seeks an RN Case Manager (The Nurse) to coordinate care for assigned patients under an established treatment plan and ensure timely transitions of care. The role requires RN licensure with Arizona preference and 1+ year case management experience.

Responsibilities include care coordination across providers, clinical liaison activities, utilization review, and data analysis to drive performance improvements. CPR/ACLS certification, or obtain within 30 days, is required.

Qualifications

• At least 1 year of case management experience; certification preferred or any other combination of education, training and/or experience.
• ASN required; BSN preferred.
• Current and active state unrestricted RN license; Arizona license preferred.
• CPR and ACLS certification or obtain within 30 days of hire.

Responsibilities

• Manages and oversees care coordination of assigned patient caseload to ensure delivery of services across care levels.
• Serves as primary clinical liaison between referral hospitals, treatment facilities and patients/families.
• Reviews charts to determine appropriate referral services based on needs.
• Facilitates and participates in patient care coordination activities to meet care needs in a timely manner.
• Collaborates with patient, family and other parties to coordinate coverage through private and governmental health plans.
• Performs utilization review to maximize reimbursement/coverage of charges.
• Responds to patient complaints and escalates issues to appropriate parties with corrective actions as needed.
• Collects and analyzes outcome data to identify best practices and improvement opportunities.
• Participates in orientation, training and quality assurance programs.

Skills

Case management

Clinical liaison

Utilization review

Education

Associate of Science in Nursing (ASN)

Bachelor of Science in Nursing (BSN)

Job description

• Job Category Case Management, Nurse
• Employee Type Non-Exempt FT
• Required Degree 2 Year Degree
• Manage Others No

Contact information

• Name Human Resources
• Phone [phone]

Description

TheNurse (RN) Case Manager performs case management of assigned patients to ensure coordination of services in accordance with established treatment plan for timely and appropriate transition of patient based on care/service needs

ESSENTIAL FUNCTIONS (include, but not limited to the following)

• Manages and oversees care coordination of assigned patient case load to ensure delivery of all covered services identified for continuity of care across all levels of care and involved providers;
• Serves as primary contact/clinical liaison between referral hospitals, treatment facilities and patients/patient’s families to ensure delivery of effective and appropriate treatment in accordance with established plan of care
• Reviews charts of assigned patients to determine appropriate referral services based on assessed patient needs
• Facilitates, schedules and/or participates in a variety of patient care coordination activities to ensure patient and/or family personal and health care needs are met in a timely manner; proactively identifies alternative resources as needed
• Collaborates with patient, family members and other involved parties to ensure coordination of care coverage through private and governmental health care plans
• Performs utilization review of patient chart to ensure compliance with established criteria to maximize reimbursement/coverage of charges
• Receives and responds to all patient complaints; researches issues for corrective action as appropriate based on findings; escalates physician/provider issues to appropriate parties and identifies alternative solutions
• Collects, trends and analyzes outcome data to be used in identifying best practices and targeting performance improvement solutions
• Participates in departmental orientation, on the job training and quality assurance programs/initiatives
• Participates in a variety of department and hospital educational programs to maintain current skill and competency levels; identifies and discusses performance or training needs with Supervisor
• Perform other duties as assigned

Requirements

• At least 1 year of recent, relevant case management experience: certification preferred or any other combination of education, training and/or experience, preferred
• Associates of Science in Nursing (ASN), required
• Bachelor of Science in Nursing (BSN), preferred
• Current and active state unrestricted RN license, Arizona state license preferred
• CPR and ACLS certification or obtain within 30 days of hire

Indian Preference and Equal Employment Opportunity

SCAHC gives preference in hiring to San Carlos Apache Tribal members and other Native Americans in accordance with the San Carlos Apache Tribe’s Tribal Preference Policy, as set forth in Section 402 of the Tribe’s Human Resources Department Policies and Procedures Manual. Otherwise SCAHC does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect him/her because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, citizenship, veteran status, military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, SCAHC complies with all applicable federal, and Tribal laws governing nondiscrimination in employment.