THIS IS A DESIGNATED AS A SAFETY SENSITIVE POSITION: 

Salary Range: $42.59 - $59.63

Education & Qualifications:

Graduate from an accredited school of nursing (RN) required, bachelors preferred.Knowledge and skills necessary to provide care appropriate to the population served in the CM Department.Two (2) or more year’s clinical experience preferred.Acute care or community social agency case management experience preferred.Utilization Review experience, preferred.Must possess good assessment, intervention, and problem solving skills. Must be able to address the physical, cognitive, emotional, financial, and psychosocial capabilities of the patient/family. Able to develop and maintain collaborative and professional relationships with multiple stakeholders (patient/family, nursing staff, physicians, payers, and external agencies). Ability to understand medical terminology and principles. Ability to communicate effectively and efficiently, verbally and in writing. Basic computer skills (Outlook, Word, Excel, and databases) are a must. Ability to meet required deadlines while maintaining expected quality. Good organizational skills, with the ability to establish priorities and switch focus with frequent interruptions.Required Certification: Case Management Certification (CCM), preferred.Required License: Current state RN license or Multistate licensure with the authority to work in WAOther: Bilingual and/or English-Spanish speaking abilities preferred. Ability to work with culturally diverse populations.

Responsibilities

Case Management: work in conjunction with the medical team in developing best discharge plan available and understanding patient/family needs and wants with safe appropriate collaboration between all partiesEducate patients, families and others on all aspects of discharge planningResponsible for the coordination and implementation of case management strategies pursuant to the Case Management PlanUtilization Review: review charts for appropriate levels of care and or continued stayWorks with physicians and insurance companies to best manage patients and their staysUtilization Review Management ProcessesReview clinical information for concurrent reviews, extending the Length of Stay for inpatients as appropriateResponsible for authorization of appropriate services for continued stay and through dischargeReport to work on time and as scheduled; complete work within designated timelinesDemonstrates the ability to adhere to the mission, ethics and goals of Lourdes HealthEstablish effective rapport with other employee’s, professional support service staff, customers, patients, families, and physiciansUse effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to:Promote improved quality of care and/or lifePromote cost effective medical outcomesPrevent hospitalization when possible and appropriatePromote decreased lengths of hospital stays when appropriatePrevent complications in patients under our care when possibleProvide for continuity of careAssure appropriate levels of care are received by patientsIdentifies barriers/variances to discharge for any patient who will unlikely meet anticipated dischargeEnters into Abstracting UR/Nurse Doc UR screenPrioritizes case reviews daily based on: Time limits for outpatients in on the unit, Medical necessity determination for continuing stay for patients and Insurance reviews requiredMarks continuing stay category on UR Nurse Doc program quick interventions or resource mobilization that can assist in meeting LOS targets for non-medically necessary variancesWhen patient situation reviewed suggest potential LOS or quality of care issues involving physicians or care team omissions, commissions or lack of action (when variances are identified), works with Care Coordination Services leadership for determination of need for further review and referralOn a prioritized case basis, conducts an assessment of the case situation to identify complex issues or dynamics involving care, treatment or dischargeRecommend with nursing leadership, that a case conference be held to problem-solve complex issues related to care, treatment, discharge, or decision-makingMay coordinate, participate in and/or assist leading of care conferencesWork in coordination with the entire medical team to move cases towards a safe dischargeDetermines need for and recommends changes in level of care and location of care based on defined standards and judgmentConsults as necessary with physician (s), patient/family, nursing staff, third party reviewers, and other disciplines regarding realistic clinical outcomes balanced with financial considerationsReviews nursing assessment as to patients home needs, self-care, safety, nutrition, financial status, transportation, family-community support etc.Document findings and recommendations from the above in the NUR module as to no needs expressed by the patient and or family, or needs that were addressed and discharge plan to suffice those needs if within our scope, or to whom referred and contact informationReview discharge instructions with patient to include but not limited to; follow-up appointment, medications ready at pharmacy at time of discharge, go over educational tools that we have to send home with patient (ex: CHF)Confers with leadership as needed about resource options for patients and familiesCross train to and perform other UR processes as time and needs requireDetermines with Risk Management staffs and/or Medical Staff Offices’ Manager when cases may require review by Risk Management, Medical Staff Services, or other related leadership staff due to concerns about safety, practice, and resource use, decision-makingProvides case assessment and referrals to community resources and hospital resources out of the EDPerforms other work as delegated in coordination of UR, Case Management needs

Benefits:  

Medical Insurance: Savers, PPO, PPO Plus offered through Blue Cross Blue Shield  

Dental Insurance: Offered through BCBS  

Vision Insurance: Offered through BCBS  

Free EAP (Employee Assistance Program)   

Paid Time Off (Up to 25 days a year)  

Employer Paid Short-Term   

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