RN Case Mgr
Job Code: 1315
Registered Nurse (RN) Case Manager, Occasional Part Time, Day Shift Every other weekend, INTEGRIS Baptist Medical Center
May also work shifts during the weekday
Preference will be given to candidates with utilization review experience
The Case Manager is responsible for the clinical and financial outcomes for an assigned caseload of patients. The Case Manager facilitates patient care during the hospitalization by managing, coordinating and monitoring resource utilization to achieve optimal clinical outcomes and financial goals. The Case Manager is responsible to proactively plan, coordinate and negotiate efficient patient movement throughout the continuum of care. In general, the Case Manager functions in the role of clinician, educator, researcher, manager and advocate to serve the best interests of the system and patient. This position requires age related competencies. Performs all other job duties as assigned. Adheres to National Patient Safety Goals as appropriate based on the level of patient contact this position requires.
INTEGRIS Health is an Equal Opportunity/Affirmative Action Employer.
* Assesses patient from clinical, social, financial perspective and coordinates post-discharge needs with care team.
* Functions as a clinical and financial resource for patients and interdisciplinary team members.
* Assists in clinical data collection utilizing established criteria and the InterQual system
* Proactively performs utilization review; communicates coverage information with third party payers, medical staff and clinical providers.
Mental Health (addendum)
* Leads age and developmentally appropriate patient education and recreational groups to address the emotional, physical and environmental needs of Mental Health and/or Chemically Dependent patients.
* Provides documentation daily in patients‘ charts on each group facilitated.
* Facilitates discharge planning to assist patients in placement and treatment following discharge.
* Participates in the development of patient plans of care to address goals of the patient (emotional, physical, spiritual, environmental) by attending treatment team meetings
* Participates in the writing of treatment plans with other program staff and physicians on hospital approved form.
* Assists in utilization review process by contacting patients‘ insurance companies to provide clinical information to authorize patient treatment.
* Serves as a patient advocate in the patients‘ needs, as well as those individuals involved with patients (as relevant).
* Assists in the development and execution of marketing the program services to appropriate entities (outpatient therapists, primary care physicians, inpatient programs, etc.).
* Completes or facilitates the completion of Emergency Detention paperwork, as well as ensure its distribution and receipt by legally designated individuals.
* Provides physician ordered therapy in the areas of individual, family and marital sessions.
* Develops and facilitates age and developmentally appropriate patient psychotherapeutic groups.
* Is responsible for reviewing and noting physician orders.
* Monitors patients‘ medications and provide education related to use and side effects.
* Monitors vital signs as indicated by physician orders or if deemed medically necessary.
* Assesses patients for appropriateness of admission to the program.
The Case Manager reports to the Director of the Case Management Services. The Case Manager meets established deadlines, attends required inservices, maintains staff competencies and completes required documentation; collaborates and works as a team player with all disciplines; presents a professional image to all customers and patients.
Mental Health Case Manager reports to the Unit Program Manager
Required Physical Demands (Subject to Reasonable Accommodation):
Keyboarding/Dexterity: Frequently; activity exists from 1/3 to 2/3 of the time
Standing/Walking: Occasionally; activity exists up to 1/3 of the time
Strength (Lift/Carry/Push/Pull): Light (Exerting up to 20 pounds of force occasionally, or up to 10 pounds of force frequently)
Talking (Must be able to effectively communicate verbally): Yes
Color Acuity (Must be able to distinguish and identify colors): Yes
Required to be on call as scheduled by the department.
Potential exposure to infectious diseases, potential physical danger from disturbed/irate patients and families.
Emotional stress due to inability to control volume of timing of referrals and necessity to respond to a wide variety of demands and expectations from patients, families, physicians, and other health care professionals.
Occupational exposure to bloodborne pathogens and other infectious materials as defined by OSHA.
This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information.
All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.
* Five (5) years experience in a variety of clinical settings (i.e., home health, inpatient, physician office, clinic) required.
* Experience with managed care and payer/provider requirements preferred.
* Current Oklahoma RN License required. BSN preferred.
* Excellent interpersonal communication and collaboration skills.
* Computer experience required. Windows preferred.