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Case Manager

3 months ago

Kennewick, United States Trios Health Full time
Job Description

This is a safety sensitive position

Wage Scale: $42.59- $59.63

Your experience matters

At Trios Health, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. Here, you’re not just valued as an employee, but as a person. As a Case Manager (RN) joining our team, you’re embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve.

Essential Functions

Clinical Care Coordination
Perform chart review to identify and assess patient needs.
Oversee education regarding financial assistance when needed, i.e. public benefit programs, community resources & support programs, rehabilitation services to attain patient planned outcomes.
Coordinate, facilitate and lead patient care conferences on complex cases involving interdisciplinary team members.
Utilize effective communication skills to resolve issues that are in the client’s patient’s best interest. Discuss both acute and chronic health issues

Utilization Management
Screen all patients to ensure correct admission status according to clinical appropriateness, i.e., inpatient, observation, at the time of admit or as soon as possible after admit.
Maintain knowledge of Medicare, Medicaid and other third party reimbursement methods and contract requirements
Facilitate observation patient flow documenting according to Policy and Procedure
Ensure patient is in the appropriate status during hospital stay according to the prescribed clinical plan of care utilizing InterQual criteria as a guideline
Make timely referrals to a physician advisor to expedite the patient’s plan of care as indicated.

Clinical Monitoring and Evaluation
Obtain payer contact information and enter into computer
Communicate reimbursement information to the patients and families as needed
Utilize clinical expertise, analytical skills and InterQual criteria to determine level of care and admission status
Interface with respective payer representatives
Responsible for the analysis of clinical information
Monitor the appropriateness of patient status
Analyze case management outcome data
Act as a resource in the appeal and denial process
Educate physicians, patient care coordinators, hospital staff, patients and families regarding criteria.
Collaborate with payers for authorizations for patient benefits and transfers providing options and alternatives as appropriate.
Maintain Utilization Management records in accordance with state, federal or other regulatory standards.
Participate in Quality Improvement activities within the organization

Provide Trios Health patients with a plan of care prior to discharge.
Maintains ability to establish and maintain a therapeutic relationship with patients, families, caregivers
Maintains ability to develop and maintain rapport, non-judgmental, accepting, and respectful of patient/family individuality and rights
Performs psychosocial assessment of patient functioning and needs including:
Emotional and mental status
Social support
Financial and resource status
Physical and ADL functioning
Substance Abuse
Physical, emotional abuse/neglect
Spiritual needs
Resources needed
Creates discharge plans based on assessment.
Informs patients and families of discharge plans and ensures agreement to plan
Identifies the need for home health services and facilitates physician agreement and orders
Develops and implements treatment plans and interventions that are relative to patient needs in the Emergency Department, i.e., patient on the consistent care program, PRC
Effectively employs and utilizes members of the multidisciplinary team in developing care plans, including participation in patient family conferences
Facilitate with ED physician faxed care guidelines for Consistent Care patients
Identify barriers to receiving care in the appropriate setting
Make referrals to community resources as necessary
Review care guidelines and or pain contract that is in place
Goals on care plans are appropriate, timely and effectively utilize community resources
Monitors progress of care plans either directly through patient/family contact or indirectly through staff and documents care plan changes according to patient need
Utilizes local resources appropriately with ability to educate patient/family regarding available resources
Understands, utilizes, and communicates information to patient/family and staff regarding discharge plans
Makes referral to community resources of patients choice
Documents according to policy
Clinical Care Station Progress note
EDIE progress note
Allscripts ED EMR
Writes legibly
Uses approved abbreviations; does not use “do not use abbreviations”
Participates in meetings as directed
Follows policies of hospital and completed mandated education as directed
Manages arrangements for family for acute to acute transfers as needed
Ensures all paperwork needed for transfer or discharge is complete within a timely manner to ensure discharge
Provide consultation as requested.
Provide assessment, evaluation and problem resolution for patients with special referral problems.
Follows policies of hospital and completed mandated education as directed.

Exhibit professional conduct and attire at all times.
Maintain a high degree of confidentiality in discussing patient information.
Use tact and courtesy when dealing with patients, staff, providers and outside agencies.

Maintains professional knowledge and skills.
Demonstrates self-directed learning, participation and continuing education to meet own professional development.

Participate in the establishment of the departmental short and long term goals.
Contribute expertise and suggestions toward establishment and implementation of department and organizational goals as appropriate.

Special projects
Assist in projects and studies as directed by Director of Quality Improvement.
Develop, update and review policies and procedures as requested.

Quality Audits
Performs chart audits on selected cases
Monitors trends and participates in the determination of need for further assessment and improvement
Using appropriate criteria reviews chart documentation to justify patient care in order to meet regulatory requirements
Assists Director in medical record audits, analysis and display of data in preparation for Medical Staff, Quality Council, and Joint Conference meetings.
Follows established procedures for obtaining and utilizing medical records.
Prepares drill down reports as requested.
Recommends improvement teams as needed.
Facilitates improvement teams as appropriate

Qualifications and requirements

  • Associate's degree in nursing
  • Bachelor's degree- Preferred 

Certification

  • Basic Life Support (BLS)
  • Active Washington State RN licensure or compact license

Minium Work Experience

FOR HOME HEALTH CARE: ONE /I l YEAR EXPERIENCE IN AN ACUTE CARE SETIING FOR THE NUCLEAR MEDICINE

RN: TWO YEARS RECENT CURRENT) STRESS TEST SUPERVISION EXPERIENCE UTILIZING BRUCE PROTOCAL ALSO PROFICIENT WITH ADENOSINE STRESS TESTING. DIPYRIDAMOLE STRESS TESTING. DOBUTAMINE STRESS TESTING AND DOBUTAMINE STRESS ECHOCARDIOGRAPHY. TWO YEARS ICU/CCU EXPERIENCE REQUIRED. CONSCIOUS SEDATION TRAINING DESIRED MUST BE PROFICIENT IN 12 LEAD EKG INTERPRETATION

Benefits:  

Medical Insurance: PPO, HRA, HDHP offered through Blue Cross Blue Shield

Dental Insurance: Offered through Delta Dental

Vision Insurance: Offered through VSP

Free EAP (Employee Assistance Program) 

Paid Time Off (Up to 25 days a year or 200 hours)

Employer Paid Short-Term and Long-Term Disability

Coverage options for Medical, Dental and Vision include: Employee, Employee & Spouse/Domestic Partner, Employee & Child, Family

 

Voluntary Benefits: 

Health Savings Account

Flex Spending Account: Medical & Dependent

Voluntary Life: including Employee, Spouse/Domestic Partner, and Child

Critical Illness: including Employee & Spouse/Domestic Partner

Hospital Indemnity

 

About our Health System
Trios is a 111-bed hospital located in Kennewick, WA, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone—your experience matters.

EEOC Statement

“Trios is an Equal Opportunity Employer. Trios is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.”