Remote RN Case Manager - 2235
2 years experience required
- 2 years (recent) experience required
The Case Manager reviews the utilization of resources and works to reduce unnecessary lengths of stay and the over utilization of hospital services. Reviews the medical record for quality and utilization indicators, recording and communicating identified variances as appropriate through data collecting forms and quality indicator monitoring processes.
Duties and Responsibilities: ·
Actively participates in educational activities/self-development to enhance professional growth. ·
Actively participates in problem solving and maintains a positive and open attitude including in times of departmental change. ·
Assumes professional accountability for continuing education and maintaining employee education record. ·
Demonstrates competency in computer knowledge of systems required to perform duties. ·
Documents appropriately and timely in the medical record. ·
Follows department policies and CMS regulations that govern department when performing duties. ·
Has working knowledge of InterQual and has ability to work with physicians to ensure compliance with admission status criteria. ·
Participates in orientation, in-services and staff meetings. ·
Participates in performance improvement activities. Understands relevance to departmental development and advancement. ·
Prevents denials of payment for hospital services rendered to patients. Provides timely insurance reviews. ·
Reviews inpatients to determine the necessity of continued stays and professional services. ·
Utilizing clinical indicators approved by medical staff, screens inpatient charts to determine which cases may need peer review.
Works collaboratively with the interdisciplinary care team to facilitate positive patient outcomes.
Education and Qualifications: ·
Currently licensed to practice as a registered nurse in the State of Oregon. ·
Graduate of an accredited school of nursing, BSN preferred. ·
Minimum 2 years recent medical/clinical RN experience in an acute hospital required (Behavioral Health RN experience does not apply), prefer Case Management RN experience or 2 years discharge planner/utilization review nurse.
Current AHA Healthcare Provider BLS/CPR certification. ·
A high regard for the dignity and worth of patients and their families. ·
Commitment to upholding and providing services in a manner that is congruent with the Medical Center's mission statement. ·
Good organizational and computer skills. ·
Ability to self-motivate and work independently.