RN Case Manager - Integris Edmond

INTEGRIS Health; Oklahoma; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Front-loaded PTO

Medical benefits through INTEGRIS

Education assistance

24/7 mental health support

Job summary

INTEGRIS Health Edmond in Edmond, OK is seeking a variable shift, full-time RN Case Manager to coordinate discharge planning and ensure patient-centered care.

Responsibilities include comprehensive assessments, care coordination, resource utilization, and collaboration with physicians, staff, and families to improve outcomes while complying with CMS and payer guidelines.

Qualifications

• 2 years experience in a clinical settings (e.g. home health, inpatient, physician office, clinic)
• BLS issued by ARC or AHA within 30 days of hire
• Current RN licensure in Oklahoma or eNLC member state
• Case Management Certification preferred
• Experience with managed care and payer/provider requirements
• Bachelor's of Science in Nursing required

Responsibilities

• Completes a comprehensive assessment of patients' clinical, psychological and financial needs using available resources
• Coordinates timely transfers to appropriate levels of care based on clinical needs and utilization criteria
• Develops and revises discharge plans with referrals to healthcare and community resources
• Communicates discharge care plan and changes to patient, family and providers
• Assists physicians and hospital staff in utilization of resources and timely discharge planning
• Coordinates services across hospital departments to expedite discharge
• Performs concurrent review of patient records and applies utilization criteria
• Notifies contacts of utilization issues affecting care or reimbursement
• Facilitates patient transfers following policy and regulations
• Advises on discharge planning, documentation, and payer rules
• Maintains knowledge of CMS, Medicare/Medicaid and payer regulations
• Educates patients and families on HCFA regulations and payer requirements
• Identifies opportunities to reduce cost while maintaining quality
• Participates in data collection for utilization and quality improvement

Skills

Interpersonal communication

Collaboration

English communication

Education

Bachelor's of Science in Nursing

Job description

Join our team as a variable shift, full time, RN Case Manager, at INTEGRIS Health Edmond, in Edmond, OK.

Get to Know Your Team:

• INTEGRIS Health, Oklahoma’s largest not-for-profit health system, is seeking a dedicated caregiver to join us in our mission to partner with people to live healthier lives.
• Benefits of being an INTEGRIS Health caregiver include front-loaded PTO, medical benefits through the extensive INTEGRIS Health network, financial assistance for continued education, 24/7 mental health support and more.
• Take the first step toward growing your career by joining us.

Responsibilities

• Completes a comprehensive assessment of patients clinical, psychological and financial needs utilizing all available resources.
• Recommends and coordinates timely transfers to appropriate levels of care as indicated by clinical needs and utilization criteria.
• Develops, implements, evaluates and revises, as necessary, a plan for discharge, including referrals to other health care and community organizations based on needs assessment.
• Communicates discharge care plan, and any changes in the plan to patient, family and all appropriate healthcare professionals.
• Assists physicians and hospital staff in appropriate utilization of resources through application of utilization criteria and facilitating timely discharge planning for patients.
• Coordinates services between hospital departments to facilitate timely patient discharge.
• Conducts concurrent review of patient records on admission to the hospital and as determined by the patient's clinical condition.
• Applies utilization criteria accurately in order to determine appropriate utilization of resources.
• Notifies designated internal and external contacts of utilization issues that may affect patient care and/or reimbursement.
• Facilitates patient transfers to other health care organizations in accordance with hospital policies and all-applicable state and federal guidelines and regulations.
• Acts as a resource/advisor to physicians regarding discharge planning, medical record documentation, and all issues that may affect resource utilization and reimbursement.
• Integrates and manages established pathways, where available, to enhance clinical effectiveness and clinical resource management.
• Maintains knowledge and understanding of CMS regulations, Medicare/Medicaid, managed care and other payer regulations and benefit limits.
• Acts as a resource and provides education for patients, their family members and all health care professionals regarding HCFA regulations, Medicare, Medicaid, managed care and other payers.
• Develops and maintains knowledge and understanding of hospital and community resources, and facilitates use of most appropriate level of care to conserve patient, hospital, and payer resources.
• Identifies opportunities to reduce cost of managing patient care without impacting quality or outcomes.
• Participates in collecting and recording data for utilization and Quality Improvement reporting. Works collaboratively and professionally with patients, family members, and physicians, hospital staff and other individuals and agencies involved in providing patient care.

Qualifications

REQUIRED QUALIFICATIONS

EXPERIENCE:

• 2 years experience in a clinical settings (e,g. home health, inpatient, physician office, clinic)

LICENSE/CERTIFICATIONS:

• BLS (Basic Life Support) Issued by American Red Cross or American Heart Association within 30 days of hire
• RN (Registered Nurse) Current licensure as a Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state

SKILLS:

• Excellent interpersonal communication and collaboration skills
• Computer experience

Must be able to communicate effectively in English (verbal/written). This job requires the incumbents to operate a INTEGRIS-owned vehicle OR personal vehicle (non INTEGRIS-owned) and therefore must have a current Oklahoma State Drivers License as well as a driving record which is acceptable to our insurance carrier.

Preferred Qualifications

EXPERIENCE:

• Experience with managed care and payer/provider requirements

EDUCATION:

• Bachelor's of Science in Nursing

LICENSE/CERTIFICATIONS:

• Case Management Certification

INTEGRIS Health is an Equal Opportunity Employer. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

About Us

INTEGRIS Health mission: Partnering with people to live healthier lives.

To our patients, that means we will partner to provide unprecedented access to quality and compassionate health care. To you, it means some of the state's best career and development opportunities. With INTEGRIS Health, you will have a genuine chance to make a difference in your life and your career.

INTEGRIS Health is the state's largest Oklahoma-owned health system with hospitals, rehabilitation centers, physician clinics, mental health facilities and home health agencies throughout much of the state.