Registered Nurse, RN | Case Manager

Forest Grove, OR, United States

POSITION SUMMARY Relocation Assistance available up to $15,000

Pay range: $45.79/hr - $69.14/hr

Analyzes patient medical records concurrently and/or retrospectively for quality assessment and discharge planning criteria. Provides supportive documentation and clinical records to insurance carriers for authorization of services. Coordinates discharge plans and orders for patients leaving the hospital including identifying needs for community services and making appropriate transition plans. This position requires creativity and problem solving, multi-tasking, and the ability to prioritize tasks and work with minimal supervision.

KEY RESPONSIBILITIES

Performed majority of the time -- :

Applies and shares knowledge of community health and social service resources.

Evaluates medical information and completes discharge needs assessments within 1 day of admission as set by established criteria, to identify patients that are at high risk of requiring post-hospital services, and the need for case management and discharge planning intervention.

Initiate and complete safe discharge plans for inpatients by arranging Home Health referrals, complex drug therapy interventions, outpatient clinic visits, skilled nursing placements, intermediate care placements, assisted living arrangements, etc.

Documents initial assessment of the patient and continually assesses discharge needs through the continuum of care.

Works closely with external vendor partners to arrange post-discharge needs, maintains amiable and professional relationship with vendors at all times.

Assesses variables that impact health and functioning, interprets clinical information and assesses implications for treatment.

Issues Important Messages from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), and denial of services letter following appropriate health plan or Medicare guidelines.

Collaborates with Hospitalists and Multi-Disciplinary team daily to facilitate the timely discharge of patients from the hospital setting.

Enters Avoidable Days and Code 44 Documentation when appropriate.

Provides information to patients and families on Advanced Directives when requested.

Responds to outpatient and community questions and referrals.

Screens patients medical records concurrently and/or retrospectively using pre-established screening criteria for quality assurance and discharge planning.

Facilitates discharge planning for the continuum of care.

Facilitates placements or referrals as appropriate to meet the patients clinical needs/rights and are specific for neonate, infant, pediatric, adolescent, adult and geriatric populations.

Reports suspected abuse, neglect, or unsafe discharge environment to the appropriate agency.

Develops an individualized case management plan that addresses physical, vocational, psychosocial, age, cultural, financial and educational needs and documents case management activities.

Coordinates the appropriate services and resources needed.

Communicates with patient/family/significant others and all multi-disciplinary team members for appropriate post-hospital services/needs.

Consults with the social worker to identify appropriate social service needs.

Provides insurance carriers with necessary information to authorize follow-up care when necessary and obtains pre-authorization for post-discharge services including Skilled Nursing, Durable Medical Equipment, Home Oxygen, or Rehabilitation.

Relays pertinent information to the Case Management Manager to represent Case Management with internal medical or quality committees, inpatient nursing staff, ancillary provider staff as appropriate.

Performed occasionally but critical to successful performance of the job:

Attends scheduled staff, care conferences, and other meetings as appropriate

Attends Utilization Review Committee meetings as schedule allows.

Shares information from seminars and other sources of education with others as appropriate.

JOB SPECIFICATIONS JOB SPECIFICATIONS

Education:

Required

Associates Degree in Nursing

Preferred

Bachelor or Master of Science in Nursing

Experience:

Required

Associates Degree in Nursing must have 3 years experience practicing as a RN; Bachelor or Master of Science in Nursing must have 2 years experience practicing as a RN

Preferred

Strong clinical nursing skills with five (5) years hospital experience in varied clinical settings

Knowledge of insurance carriers and Medicare guidelines in the hospital environment

Knowledge of community health and social service resources

Licenses, Certifications and/or Registrations:

Required

Current license as a Registered Nurse by the Oregon State Board of Nursing

American Heart Association Healthcare Provider BLS

Preferred

Certification in Case Management from ACMA Or CMSA

Certified Medical Translator

Job Related Skills, Abilities and Behaviors:

Required

Demonstrates ethical commitment to quality assurance and confidentiality of all data and information

Emulates dress code and Code of Conduct that incorporates presenting a good first and lasting impression by personal appearance and interpersonal skills

Advanced communication and interpersonal skills that utilizes consideration body language, filters, listening, paraphrasing, and questions with customers of diverse ethnic and cultural backgrounds. This also includes the skills to obtain and interpret information appropriate to patients' needs and age as required for assessment, range of treatment and patient care

Ability to write clear and legible clinical notes

Experience working in highly confidential settings

Possesses excellent telephone skills and interpersonal communication abilities both verbal and written

Ability to develop case management care plans and solutions utilizing critical thinking and problem-solving skills

Familiar with computerized word processing and electronic medical records

Ability to implement ideas and programs required

Self-directed and must be able to follow through on projects with attention to detail and implement ideas and programs with minimal supervision

Demands creativity, flexibility and the ability to work under stress

Applies problem-solving techniques to the case management process

Maintains familiarity with disease processes, available resources and treatment modalities, assessing their quality and appropriateness for specific disabilities, illnesses and injuries

Provides care appropriate to the age of patients served pediatric, adolescent, adult, and geriatric patients based on principles of growth and development and life stages

Demonstrates confidentiality according to PHI regarding patient and co-worker information

Demonstrates an understanding of insurance policy language and various health care options

Responds to correspondence independently, as appropriate

Exhibits the ability to learn "just in time" and shares findings with others

Demonstrates ability to work in a team situation

Ability to facilitate family care conferences, manage multiple interruptions, communicate effectively with patients and act as patient advocate

Advocates and respects patients rights and/or significant others rights

Utilizes problem-solving techniques consistently to resolve complaints or concerns

Maintains a cooperative and harmonious relationship with staff and management

Demonstrates respect of others, communicates clearly and attempts to resolve interpersonal conflicts

Develops and maintain collegial relationships with other professionals by attending continuing education and professional group sessions

Preferred

Bilingual skills a plus

#Tier4

Additional Posting Information Hillsboro Medical Center believes in providing equal employment opportunities for all qualified individuals. Recruitment, hiring, promotions, transfers, working conditions, training, and compensation will be based on qualifications without regard to race, color, sex, sexual orientation, gender identity, religion, age, creed, national origin, marital status, family relationship, veteran status, genetic information, physical or mental disability, or any other status or characteristic protected by applicable law. We further commit ourselves to continuing the practical application of this policy in our daily business conduct.