Registered Nurse, RN | Case Manager

Hillsboro Medical Center; Hillsboro (OR); On-site; USD 141,820,000 - 212,324,000; Full time

Job summary

Hillsboro Medical Center in Hillsboro, Oregon is seeking an experienced RN Case Manager to analyze patient records and coordinate discharge planning. You will support insurance authorizations, arrange post-discharge services, and collaborate with hospitalists and a multi-disciplinary team to ensure safe, timely transitions from hospital to community-based care.

The role emphasizes problem solving, prioritization, and effective communication with patients, families, and providers, including

Qualifications

• Associates degree in Nursing required.
• RN with 3 years experience for ADN; BSN/MSN requires 2 years.
• Current RN license in Oregon and AHA BLS.
• Knowledge of Medicare guidelines and discharge planning.
• Experience with case management and post-discharge coordination.

Responsibilities

• Apply knowledge of community health and social services resources.
• Evaluate discharge needs within 1 day of admission to identify high-risk patients.
• Arrange Home Health, complex drug therapy, outpatient visits, skilled nursing and other placements.
• Document initial assessments and ongoing discharge needs.
• Collaborate with external vendors to arrange post-discharge services.
• Assess factors that affect health and treatment implications.
• Provide pre-authorization information to insurance carriers for services.
• Coordinate with Hospitalists and the multi-disciplinary team to discharge patients.
• Enter Avoidable Days and Code 44 documentation when appropriate.
• Educate patients and families on Advanced Directives when requested.
• Respond to outpatient and community questions and referrals.
• Screen medical records for quality assurance and discharge planning.
• Facilitate discharge planning across continuum of care and placements.
• Report abuse or unsafe discharge to the appropriate agency.
• Develop individualized case management plans addressing physical, psychosocial, and age-related needs.
• Communicate with patients/families and the care team about post-hospital services.
• Consult social worker to identify appropriate social service needs.

Skills

Clinical nursing skills

Communication skills

Confidentiality

Team collaboration

Education

Associates Degree in Nursing

Bachelor or Master of Science in Nursing

Tools

EMR/EHR Systems

Job description

POSITION SUMMARY

Pay range: $49.34/hr - $74.08/hr plus 10% per diem differential

Analyzes patient medical records concurrently and/or retrospectively for quality assessment and discharge planning criteria. Provides supportive documentation and clinical records to insurance carriers for authorization of services. Coordinates discharge plans and orders for patients leaving the hospital including identifying needs for community services and making appropriate transition plans. This position requires creativity and problem solving, multi-tasking, and the ability to prioritize tasks and work with minimal supervision.

KEY RESPONSIBILITIES –

• Applies and shares knowledge of community health and social service resources.
• Evaluates medical information and completes discharge needs assessments within 1 day of admission as set by established criteria, to identify patients that are at high risk of requiring post-hospital services, and the need for case management and discharge planning intervention.
• Initiate and complete safe discharge plans for inpatients by arranging Home Health referrals, complex drug therapy interventions, outpatient clinic visits, skilled nursing placements, intermediate care placements, assisted living arrangements, etc.
• Documents initial assessment of the patient and continually assesses discharge needs through the continuum of care.
• Works closely with external vendor partners to arrange post-discharge needs, maintains amiable and professional relationship with vendors at all times.
• Assesses variables that impact health and functioning, interprets clinical information and assesses implications for treatment.
• Issues Important Messages from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), and denial of services letter following appropriate health plan or Medicare guidelines.
• Collaborates with Hospitalists and Multi-Disciplinary team daily to facilitate the timely discharge of patients from the hospital setting.
• Enters Avoidable Days and Code 44 Documentation when appropriate.
• Provides information to patients and families on “Advanced Directives” when requested.
• Responds to outpatient and community questions and referrals.
• Screens patient’s medical records concurrently and/or retrospectively using pre-established screening criteria for quality assurance and discharge planning.
• Facilitates discharge planning for the continuum of care.
• Facilitates placements or referrals as appropriate to meet the patient’s clinical needs/rights and are specific for neonate, infant, pediatric, adolescent, adult and geriatric populations.
• Reports suspected abuse, neglect, or unsafe discharge environment to the appropriate agency.
• Develops an individualized case management plan that addresses physical, vocational, psychosocial, age, cultural, financial and educational needs and documents case management activities.
• Coordinates the appropriate services and resources needed.
• Communicates with patient/family/significant others and all multi-disciplinary team members for appropriate post-hospital services/needs.
• Consults with the social worker to identify appropriate social service needs.
• Provides insurance carriers with necessary information to authorize follow-up care when necessary and obtains pre-authorization for post-discharge services including Skilled Nursing, Durable Medical Equipment, Home Oxygen, or Rehabilitation.
• Relays pertinent information to the Case Management Manager to represent Case Management with internal medical or quality committees, inpatient nursing staff, ancillary provider staff as appropriate.

Performed occasionally but critical to successful performance of the job:

• Attends scheduled staff, care conferences, and other meetings as appropriate.
• Attends Utilization Review Committee meetings as schedule allows.
• Shares information from seminars and other sources of education with others as appropriate.

JOB SPECIFICATIONS

Required

Education:

• Associates Degree in Nursing

Preferred

Education:

• Bachelor or Master of Science in Nursing

Required

Experience:

• Associates Degree in Nursing must have 3 years’ experience practicing as a RN; Bachelor or Master of Science in Nursing must have 2 years’ experience practicing as a RN

Preferred

Experience:

• Strong clinical nursing skills with five (5) years hospital experience in varied clinical settings
• Knowledge of insurance carriers and Medicare guidelines in the hospital environment
• Knowledge of community health and social service resources

Required

Licenses, Certifications and/or Registrations:

• Current license as a Registered Nurse by the Oregon State Board of Nursing
• American Heart Association Healthcare Provider BLS

Preferred

Licenses, Certifications and/or Registrations:

• Certification in Case Management from ACMA Or CMSA
• Certified Medical Translator

Required

Job Related Skills, Abilities and Behaviors:

• Demonstrates ethical commitment to quality assurance and confidentiality of all data and information
• Emulates dress code and Code of Conduct that incorporates presenting a good first and lasting impression by personal appearance and interpersonal skills
• Advanced communication and interpersonal skills that utilizes consideration body language, filters, listening, paraphrasing, and questions with customers of diverse ethnic and cultural backgrounds. This also includes the skills to obtain and interpret information appropriate to patients' needs and age as required for assessment, range of treatment and patient care
• Ability to write clear and legible clinical notes
• Experience working in highly confidential settings
• Possesses excellent telephone skills and interpersonal communication abilities both verbal and written
• Ability to develop case management care plans and solutions utilizing critical thinking and problem-solving skills
• Familiar with computerized word processing and electronic medical records
• Ability to implement ideas and programs required
• Self-directed and must be able to follow through on projects with attention to detail and implement ideas and programs with minimal supervision
• Demands creativity, flexibility and the ability to work under stress
• Applies problem-solving techniques to the case management process
• Maintains familiarity with disease processes, available resources and treatment modalities, assessing their quality and appropriateness for specific disabilities, illnesses and injuries
• Provides care appropriate to the age of patients served pediatric, adolescent, adult, and geriatric patients based on principles of growth and development and life stages
• Demonstrates confidentiality according to PHI regarding patient and co-worker information
• Demonstrates an understanding of insurance policy language and various health care options
• Responds to correspondence independently, as appropriate
• Exhibits the ability to learn “just in time” and shares findings with others
• Demonstrates ability to work in a team situation
• Ability to facilitate family care conferences, manage multiple interruptions, communicate effectively with patients and act as patient advocate
• Advocates and respects patients’ rights and/or significant other’s rights
• Utilizes problem-solving techniques consistently to resolve complaints or concerns
• Maintains a cooperative and harmonious relationship with staff and management
• Demonstrates respect of others, communicates clearly and attempts to resolve interpersonal conflicts
• Develops and maintain collegial relationships with other professionals by attending continuing education and professional group sessions

Preferred

• Bilingual skills a plus

Hillsboro Medical Center believes in providing equal employment opportunities for all qualified individuals. Recruitment, hiring, promotions, transfers, working conditions, training, and compensation will be based on qualifications without regard to race, color, sex, sexual orientation, gender identity, religion, age, creed, national origin, marital status, family relationship, veteran status, genetic information, physical or mental disability, or any other status or characteristic protected by applicable law. We further commit ourselves to continuing the practical application of this policy in our daily business conduct.