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RN Case Manager

2 months ago


Shelton, United States Mason Health Full time
Case Manager: This 1.0FTE/Full-time position is scheduled to work 10-HR day shifts.

Compensation: Non-exempt, $46.32/HR-$67.29/HR

Benefits:

Mason Health provides an excellent benefit package to Part-time and Full-time employees, including:
  • Medical, Dental & Vision Insurance
  • Retirement/ Deferred Compensation plans
Mason Health will make employer contributions of 8% of your compensation for each pay period that you contribute at least 5% of your compensation.
  • Paid Time Off, accrue up to 8 hours of PTO per bi-weekly pay period
  • Life Insurance
  • Employee Assistance Program
  • Mental Health & Wellness resources
  • Tuition Assistance Program
  • Optional or elective benefits include:
  • Flexible Spending Account
  • Short & Long term disability insurance


Job Summary:
The Case Manager manages utilization reviews and coordinates case management. Performs concurrent admission and continued stay reviews. Contributes and assists in the performance of case management activities, and contributes to the assessing, planning, implementing, coordinating, monitoring and evaluating of the needs of patients for services both during and after hospitalization.

Job Specific Duties & Responsibilities:
  1. Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the hospital.
  2. Works with physicians regarding proper documentation and appropriateness of stay. Acts as a resource for staff in proper aspects of care. Works in conjunction with the House Supervisors to ensure accuracy of on-going patient status assignments.
  3. Provides clinical information requested by the managed care companies as part of the concurrent review in a timely fashion.
  4. Works collaboratively with physicians and managed care companies on concurrent denial appeals
  5. Performs focused assessment of needs for successful transition to home or other care settings. Collects data and contributes to goal-oriented care and treatment plan. Collects data from a variety of sources such as patient records, interviews, observation, and team members. Documents patient assessment and progress appropriately. Coordinates team-based care through effective partnerships with patients, their caregivers, and their providers. Communicates issues, variances and problems appropriately.
  6. Facilitates patient/family navigation through the healthcare system for assigned patients. May facilitate access to appropriate primary and specialty providers as well as other care coordination team support specialists (e.g. Diabetes Educators, Registered Dieticians).
  7. Serves as the point-of- contact, advocate, and informational resource for assigned patients, family, care team, payers and community resources. Proactively acts as patient advocate; responding with empathy and respect to resolve patient/family concerns.
  8. Functions as an active member of the Utilization Review/Medical Records Committee. Assists in periodic reviews, evaluations of Utilization Review policies and procedures.
  9. Supports continuing QA/QI at Mason Health and actively participates in all aspects of accreditation
  10. Participates in the development/implementing/in servicing and evaluation of standards of care/policies/procedures and protocols for the department of nursing.
  11. Other duties as assigned.
Required Education and Experience:
  1. Graduate of an accredited school of nursing and current license as an RN in Washington State
  2. 3 years of experience in a hospital setting
Required Licenses, Certifications and/or Registrations:
  1. Registered Nurse License-Washington State