Case Manager RN

Job Summary: The Case Manager is responsible for evaluating care for patients ranging in age from birth to geriatric. Performs concurrent review including admission, continued stay and appropriateness of discharge. Collects information for and as a result of concurrent reviews. Participates in discharge planning to ensure continuity of care and utilization review. Participates in functions to coordinate the care of patients with all health team members throughout the facility. Integrates Case Management within the hospital’s primary functions in a manner that contributes to the provision of comprehensive healthcare and achievement of quality cost effective outcomes. 

Demonstrates Competency in the Following Areas:

· Reviews patient medical records on a daily basis to perform pre-certification and concurrent review. Prepares worksheet for each patient that captures appropriate documentation of admission, continued stay and discharge.

· Advises and communicates daily with the physicians, nursing staff, and other ancillary personnel in regards to appropriate utilization and coordination of health care services and assist patients through the health care system (i.e. clinical pathways).

· On a concurrent basis, reviews the appropriateness of the level of care; diagnostic testing and clinical procedures; quality and clinical risk issues; and documentation of medical record completeness.

· Conducts continued stay reviews for patients, using approved criteria. Contacts private insurance carrier for continued stay as necessary.

· Monitors physicians’ progress notes in order to determine that adequate and timely documentation exists to indicate the medical necessity and appropriateness to further hospital care.

· Confers with attending physician when appropriate to make determination about the medical necessity for admission or continued stay.

· Demonstrates satisfactory level of interpersonal skills to interact with Medical staff, facility staff, Administration, patients, families, customers, vendors, and government agencies.

· Demonstrates ability to prioritize tasks/responsibilities and complete duties within allotted time.

· Participates as a team member in a multi-disciplinary approach in a genuine effort to ensure continuity of care, quality patient care services and appropriate utilization of resources.

· Utilizes appropriate resources in an effort to decrease the length of stay while at the same time utilizing cost effectiveness and ensuring quality care for the patient.

· Evaluates and screens patients for utilization issues and confers with utilization experts on the care management team regarding specific cases.

· Strives to maintain a good rapport with physicians and other staff members. Is active in promoting a positive, cooperative working environment and maintains good interdepartmental relationships.

· Responds promptly and effectively in time of crisis which may include being called in or staying late in time of need.

· Completes all annual employee requirements prior to evaluation date. Keeps all licenses and certifications current.

· Maintains a good work record. Reports to work on time and has limited absences and timely notification of any illness or absence.

· Shows flexibility in assignment of work hours and duties as needed.

· Demonstrates support of the organization’s mission by observing policies and procedures, participating in the department/organization activities, and working cooperatively with other staff.

· Works as a competent member of the team, willingly providing back-up support to colleagues when appropriate and actively supporting group goals.

· Represents the organization in a positive manner in the community as well as the workplace.

Education/Regulatory Requirements & Experience:

· Graduation from an accredited school of nursing with a RN degree.

· Valid Certified Case Manager credential preferred.

Experience:

· Two years experience in an acute hospital Case Management, Utilization Review or as a health care provider. 

· Previous work history that demonstrates steady attendance and punctuality is required.

Certificates, Licenses, Registrations:

· Valid Oklahoma RN license

· CCM credential preferred

Skills:

· Ability to apply common sense understanding to carry out instruction furnished in written oral and/or diagram form.

· Ability to define and solve problems, collect data, establish facts and draw valid conclusions. 

· Ability to interpret an extensive variety of technical instructions in statistical or diagram form and deal with several abstract and concrete variables. 

· Excellent communication skills required.

Physical Demands:

· Near visual & hearing acuity required to perform essential duties of position. Must be in general good health and demonstrate emotional stability in order to cope with mental and emotional stress of the position.

· Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising client care.