RN Case Manager - Utilization Review - Baptist Emergency Dept

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

Benefits offered by this job

Front-loaded PTO

Medical benefits

Education assistance

24/7 mental health support

Job summary

INTEGRIS Health in Oklahoma City, OK is seeking a full-time RN Case Manager for Utilization Review in the Emergency Department. This on-site role supports clinical and financial outcomes by coordinating care and managing resource use.

The position requires 2 years of clinical experience, Oklahoma RN licensure (or compact), BLS, strong communication, and ability to work with CMS/Medicare/Medicaid guidelines. A BSN and Case Management Certification are preferred.

Qualifications

• 2 years experience in a clinical settings (e.g. home health, inpatient, physician office, clinic)
• Excellent interpersonal communication and collaboration skills
• Must have Oklahoma State Driver's License and driving record acceptable to insurance

Responsibilities

• The Case Manager is responsible for clinical and financial outcomes for an assigned caseload.
• Facilitates patient care during hospitalization by coordinating and monitoring resource utilization.
• Plans, coordinates and negotiates efficient patient movement throughout the continuum of care.
• Communicates discharge plan and changes to patient, family, and healthcare professionals.
• Coordinates services between hospital departments to facilitate timely discharge.
• Maintains knowledge of CMS regulations, Medicare/Medicaid, managed care and payer regulations.

Skills

Interpersonal communication

Education

Bachelor's of Science in Nursing

Job description

OK, United States

Job Description

Join our team as a full time days and every other weekend ON-SITE RN Case Manager -Utilization Review in the INTEGRIS Baptist Emergency Dept, Oklahoma City, 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.

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

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.

Responsibilities

The Case Manager is responsible for the clinical and financial outcomes for an assigned caseload of patients as appropriate. The Case Manager facilitates patient care during the hospitalization by managing, coordinating and monitoring resource utilization to achieve optimal clinical outcomes and financial goals. The Case Manager is responsible to proactively plan, coordinate and negotiate efficient patient movement throughout the continuum of care. In general, the Case Manager functions in the role of clinician, educator, researcher, manager and advocate to serve the best interests of the system and patient. Adheres to National Patient Safety Goals as appropriate based on the level of patient contact this position requires. INTEGRIS is an Equal Opportunity/Affirmative Action 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.

The RN Case Manager responsibilities include, but are not limited to, the following:

• 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.

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.