Qureos Mentor

Bothwell Regional Health Center

JOB SUMMARY: 
The RN Case Manager is a Case Manager responsible for mentoring and serves as a resource to other utilization management team members. The RN Case Manager is responsible for admission and concurrent review of patients for Severity of Illness and Intensity of Service, appropriate level of care and discharge planning as outlined in the Utilization Management Plan. The Case Manager reviews concurrently and must facilitate and encourage the optimal use of the Health Centers resources through interventions with both medical staff and the healthcare team as needed to facilitate timely discharge.
 
The RN Case Manager reports directly to the Director of Case Management.
 
QUALIFICATIONS: 
Education: 
a.) RN from an accredited school, college or university.
 
Licensure/Certification: 
Current RN nursing license required.
 Certification in Case Management, preferred.
 
Work Experience: 
a.) Two years’ recent clinical experience, or utilization review, utilization management, or case management.
 
RESPONSIBILITIES/JOB DUTIES: 
Responsible for implementing the Utilization Management Plan.
 
Assesses and evaluates all patients in assigned area for care needs along the continuum and facilitates interventions with the healthcare team as needed. Initiates immediate action steps on problematic cases by strategizing approaches with physicians, nursing and ancillary departments, etc., for timely and efficient resolution of their concerns.
 
Establishes a discharge plan with the patient/family and healthcare team. Assesses and recommends appropriate treatments and follow up care based on sound pathophysiological rationale. Obtains prior authorizations as needed. Understands medical care regimen and interacts actively with the patient/family, physicians and healthcare team to review discharge plans and to ensure appropriate movement along the continuum of care.
 
Concurrently reviews patients for continued medical necessity of hospitalization, level of care, efficient utilization of ancillary and support services, quality issues, delays in services, potential discharge planning problems and makes appropriate referrals to members of the healthcare team.
 
Reviews readmissions to determine if discharging planning was appropriate or if additional services are required to provide a safe discharge plan.
 
Identifies opportunities to improve existing policies and procedures and seeks appropriate resources and channels to effect change. This could include new tasks as the landscape of healthcare evolves.
 
Demonstrates clinical expertise by applying current knowledge and research in planning and evaluating patient care within area of specialty.
 
Demonstrates knowledge of cost containment strategies that impact patient care and outcomes, and ensures that the plan of care and outcomes identified support cost effective, quality outcomes achievable within the anticipated length of stay.
 
Serves as a leader in committees, professional organization and/or health related organizations at the local or regional level.
 
Identifies staff educational needs related to specific patient population, plans, and develops and implements education plan in collaboration with Nursing.
 
Serves as a resource in the Case Management department and to other members of the healthcare team.
 
Other duties as assigned by supervisory and leadership staff.
 
REQUIRED STAFF COMPETENCIES: 
Demonstrates support for organizational and departmental mission.
 
Supports and demonstrates knowledge of the Strategic Plan and the Hospital Key Initiatives.
 
Fosters and promotes teamwork within department and the organization as a whole.
 
Works to resolves conflicts constructively and in a timely manner.
 
Ability to communicate effectively and simply with every customer and co-
 worker.
 
Ability to display a positive, courteous and friendly attitude toward all contacts.
 
Ability to build good relationships with others based upon a sustained effort of
 mutual support toward common goals.
 
Ability to exercise good judgment, reasoning and concentration to detail and to
 take personal accountability for all actions in carrying out job duties.
 
Is customer focused and committed to Quality and Process Improvement with a
 strong desire to provide service excellence.
 
Possesses and displays a strong knowledge and understanding of the standards of
 practice for their position including, if and when applicable, commensurate
 computer skills; population specific and general competencies; organizational
 skills, time and project management.
 
Possesses a vigorous and enthusiastic desire to learn and to grow both personally
 and professionally, and to improve one's skills in order to deliver the best possible
 care for our customers.
 
WORKING CONDITIONS: 
Subject to long and irregular working hours; frequent interruptions.
 
Sitting and standing for prolonged periods of time.
 
Works indoors in well-lighted and ventilated office environment.

RN Case Manager

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Bothwell Regional Health Center

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RN Case Manager