RN Case Manager-Inpatient-Acute Observation
RN Case Manager-Inpatient-Acute Observation
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1 Vacancy
Job Description
Overview
Now hiring a RN Case ManagerInpatientAcute Observation
Applies Case Management principals in coordinating patient care across the continuum using assessment care planning implementation coordination monitoring and evaluation for cost effective and quality outcomes in a primarily inpatient setting including complex discharge planning.
Performs Utilization Management clinical review to ensure that services rendered to members meet clinical criteria and are delivered in the appropriate setting. Utilizes clinical skills and knowledge to coordinate document and communicate all aspects of the utilization/benefit management program. Performs care review both prospectively and retrospectively. Prospective review includes preservice and concurrent services and procedures. Validates and interprets medical documentation using evidencebased criteria sets. Consults with PHP medical directors and refers for medical director decision on cases not meeting clinical criteria. Identifies members with complex conditions requiring one on one case management and/or disease management services and refers appropriately to the Presbyterian Integrated Care Management program.
How you belong matters here.
We value our employees differences and find strength in the diversity of our team and community.
At Presbyterian its not just what we do that matters. Its how we do it and it starts with our incredible team. From Information Technology to Food Services and beyond our nonclinical employees make a meaningful impact on the healthcare provided to our patients and members.
Why Join Us
- Full Time Exempt: Yes
- Job is based Rev Hugh Cooper Admin Center
- Work hours: Days
- Benefits: We offer a wide range of benefits including medical wellness program vision dental paid time off retirement and more for FT employees.
Ideal Candidate:
- Bachelors degree in Nursing Business or Health related field
- Five years of experience in relevant clinical nursing
- minimum of two years of recent pertinent experience in clinical adult inpatient setting or NICU for NICU team or ICU or Medical Surgical Hospital clinical nursing and utilization review or case management within the last 10 years.
Qualifications
- Bachelors degree in Nursing Business or Health related field preferred. RN license required.
- Five years of experience in relevant clinical nursing.
- Requires a minimum of two years of recent pertinent experience in clinical adult inpatient setting or NICU for NICU team or ICU or Medical Surgical Hospital clinical nursing and utilization review or case management within the last 10 years.
- National certification in Case Management preferred within 3 years of hire.
- Computer knowledge to include Windows Word Excel and database systems.
- Ability to analyze trends based on decision support systems.
- Knowledge in referral coordination to community & private/public resources.
- Good organizational and time management skills.
- Ability to articulate orally and in writing an understanding of complex issues and action plans while best representing the organization professionally.
- Ability to work cooperatively with other employees and departments.
- Efficient and comfortable with computer electronic data entry and documentation.
- Ability to succinctly document using correct spelling and grammar.
- Able to summarize from medical clinical notes.
- Ability to assertively and professionally interact with providers and compassionately assist members.
- Demonstrate critical thinking skills as evidenced by experience education and/or the prehire interview process.
Responsibilities
- Receives reviews verifies and processes requests for approval of preservice and concurrent services including verification of eligibility and availability of benefits.
- Identifies and advocates for members in caseload referring to appropriate inpatient outpatient and community resources including care coordination.
- Conducts an indepth assessment which includes psychosocial physical medical environmental and financial parameters. Collaborates with Healthcare team to proactively develop implement and document treatment and discharge plan with appropriate resources to address social physical mental emotional spiritual and supportive needs.
- Collaboratively formulates implements coordinates monitors and evaluates strategies with the healthcare team to address care management issues for specific patients and disease processes
- Applies utilization review criteria to assess and document the appropriateness of admission continued stay level of care and readiness for discharge; refers cases that do not meet criteria to designated Physician Advisor. Promotes the appropriate use of clinical and financial resources in order to improve quality of care and patient/member satisfaction.
- Advises manager/supervisor of possible trends in inappropriate utilization (under and/or over) and other quality of care issues.
- Communicates effectively with providers PHP medical directors Members PHP departments as evaluated by supervisory audits
- Educates providers and other PHS/PHP departments on health management strategies and care coordination services
- Meets departmental and/or regulatory turnaround times for prior authorizations and concurrent reviews while maintaining productivity and quality standards.
- Performs other functions as required.
Benefits
All benefitseligible Presbyterian employees receive a comprehensive benefits package that includes medical dental vision shortterm and longterm disability group term life insurance and other optional voluntary benefits.
Wellness
Presbyterians Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your wellbeing. Earn gift cards and more by taking an active role in our personal wellbeing by participating in wellness activities like wellness challenges webinar preventive screening and more.
Why work at Presbyterian
As an organization we are committed to improving the health of our communities. From hosting growers markets to partnering with local communities Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients members and the communities we serve. We are locally owned notforprofit healthcare system of nine hospitals a statewide health plan and a growing multispecialty medical group. Founded in New Mexico in 1908 we are the states largest private employer with nearly 14000 employees including more than 1600 providers and nearly 4700 nurses.
Our health plan serves more than 580000 members statewide and offers Medicare Advantage Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drugfree and tobaccofree employer with smoke free campuses.
Maximum Offer for this position is up to
Compensation Disclaimer
Required Experience:
Manager
Employment Type
Full-Time
