Summary:
The Staff Pad is honored to partner with a non-profit healthcare system in Helena, Montana with superior care and a hometown commitment to be the gold standard for health care in Montana. We are in search of a RN Care Manager to join their team.
Job Description
In collaboration with the patient/family, physicians, and the interdisciplinary team, the Case Management/Utilization Review RN facilitates the patient’s progress through the Emergency Room and acute episode of care in an efficient and cost-effective manner. The CM/UR RN is responsible for assuring and monitoring the level of care from the ED through discharge. This includes initiating evidence based protocols and order sets according to the patient’s admission diagnosis, influencing the progression of care, facilitating the patients’ navigation through the acute care episode, and proposes an appropriate transition plan within 24 hours of admission. The CM/UR RN serves as an advocate for the patient and family throughout the ED experience and/or entire acute episode of care.
Aptitudes:
- Excellent interpersonal communication and negotiation skills.
- Knowledge of community and system resources
- Strong organizational and time management skills
- Ability to work independently
- Word, Excel and Meditech experience preferred
Responsibilities
Access Management/ED Coordination:
- Collaborates real-time with medical staff to assure correct admission status and confirm treatment goals, treatment plan, and clinical mileposts used to advance the treatment plan.
- Meets with patient and family, observes clinical status, and communicates with the patient’s healthcare team to assess and document the patient’s navigation and transition needs.
- Coordinates patient information to assure timely reviews according to UR work plan and follow-up with E.H.R. physician consultants
- Identifies potential financial barriers to the progression of care and makes referrals to a Social Worker Counselor or financial counselor, or other services as needed to swiftly resolve.
- Using pre-determined high-risk screens to identify selected patients with potential transition challenges and assigns to the Social Worker Counselor for focused management.
- Confirms admission diagnosis and correct admission status and identifies related quality measures to promote medical compliance.
Progression of Care
- Collaborates with admitting physician, ED physicians, Hospitalists, Documentation Specialist and other ancillary staff to assist with the initial patient assessment and high risk screen for the purpose of resource management.
- Promotes adherence to clinical protocols through collaboration with the physician and interdisciplinary team to encourage evidence based interventions relevant to the patient’s reason for admission and immediate acute care needs.
- Provides point-of-care coaching to the medical staff for documentation improvement and observance of safety and quality indicators to support admission status and care plan.
- Accompanies physicians and Hospitalists on patient rounds based on patient priorities and suggests treatment alternatives to reduce discretionary resource consumption and reduce excessive length of stay.
- Initiates referrals in collaboration with nursing staff for home health, hospice, DME, rehab, etc. and aligns the needs of patients with placement options that are consistent with the desired quality target and patient’s financial resources.
- Consults with the Medical Advisor as necessary to resolve barriers through appropriate administrative and medical channels.
- Demonstrates pro-active communication to influence treatment plan and progression of care while advocating on behalf of the patient and organizational stakeholders.
- Attends daily Hospitalist/staffing meetings and promotes CM/UR RN role as an adjunct to the team’s clinical expertise.
Transition/Discharge
- Identifies patient/families with complex psychosocial or continuing care needs that may present obstacles for a safe transition to a lower level of care or discharge to the community and makes a referral to the Social Worker Counselor.
- Works in tandem with Social Worker Counselor to monitor the progress of completing complex discharge plans and collaborates to resolve challenges.
- Facilitates patient movement to alternate levels of care within the hospital through collaboration with patient/family, physician, and interdisciplinary team and takes responsibility for moving patients to Swing Bed status as appropriate. Responsible for assuring that Swing Bed documentation is initiated and completed as per regulatory requirements.
- If CM/UR RN is not able to follow patient through entire episode of care, directly communicates patient plan of care, progression of care barriers, and probable transition needs to receiving case manager to follow, on a daily basis.
Additional performance expectations
- Functions as a member of a self directed Care Management work team ensuring appropriate coverage as indicated by the needs of the department and population served. Demonstrates competence to perform all areas included in the Care Management/UR RN job role which includes daily assignment as:
- Utilization Review Specialist: receives information from the RN assigned to the ED related to admission status and utilization review and does daily follow-up on all communication with the E.H.R, physician consultants. Performs daily insurance certifications for inpatients and utilization reviews on patients not admitted through the ED.
- ED Case Manager: Using InterQual severity of illness/intensity of service criteria, evaluates the patients’ status and need for acute care services prior to admission to assure appropriateness of the admission status and communicates daily with the other RN CM/UR staff on patient’s status. ED Case Manager will work closely with the ED physicians and staff to assure patients who are not admitted receive appropriate outpatient referrals and follow-up.
- Discharge Planning: Works with staff and physicians on the inpatient units to assure appropriate discharge referrals for home health, hospice, assisted living and skilled nursing facilities and assists the units in ordering appropriate DME and Oxygen when needed. Assures timeliness of discharges to meet patients’ needs and to support utilization standards.
- Participates on committees within the department, service lines, facility, and St Peter’s community and managed care organizations relevant to case management and utilization review activities.
- Participates in performance improvement activities, as defined in the departmental plan.
- Participate in orientation of new employees
- Using objective data; works with the department’s Director to prepare a monthly update of work accomplishments that can be incorporated into the department’s quality report card.
- Participates in departmental functions.
- Works in harmony and unison with all personnel within the department and throughout St Peter’s Hospital.
- Promotes and assists in the smooth, efficient delivery of departmental services to patients and physicians.
- Completes and/or attends all required educational offerings annually.
- Demonstrates the ability to manage time, coordinate departmental functions and promote departmental and professional growth.
- Ability to use electronic software applications related to case management activities. Operates copying machine, fax machine, and computer. Handling AV equipment, materials, supplies, and patient belongings.
- Performs other duties and responsibilities as assigned and within time frame specified.
- Will rotate with other CM/UR RNs to provide week-end and holiday coverage for discharge planning and utilization review over-site.
Qualifications
KNOWLEDGE/EXPERIENCE:
- Minimum of 3-5 years of acute care experience.
EDUCATION:
- Clinical preparation. Registered Nurse Required.
- Baccalaureate degree or equivalent experience preferred.
LICENSE/CERTIFICATION/REGISTRY: Licensure in the State of Montana. Certification in Case Management and/or Utilization Review desired.
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