RN Case Manager
Company: Renown Health
Posted on: June 15, 2019
A clinical position that works within a collaborative process to
assess, plan, implement, coordinate, monitor, and evaluate options
of care, services and alternative levels of care to meet an
individual's needs and facilitate appropriate discharge and length
of stay. By assuming a leadership role with the interdisciplinary
team, the Case Manager promotes appropriate utilization of care and
services, and cost effective outcomes. The Case Manager is
responsible for Utilization Review, of the medical record to ensure
care and services are delivered timely and appropriately. This
positions is responsible to reduce and/or eliminate avoidable
Nature and Scope
The Case Manager has the responsibility to promote case management
activities through the health continuum, beginning in the acute
setting. Case management begins with the assessment of pre-morbid
health status, current medical condition and post-acute needs. The
Case Manager works closely with the Bed Day RN who performs
admission and concurrent continued stay reviews, together they
ensure that services are being delivered at the most appropriate
level of care to meet the client's needs and to secure
reimbursement from payers.
Utilizing an interdisciplinary team approach, the Case Manager acts
as a consultant and educator on matters referring to alternative
levels of care and managed care issues,. In collaboration, to
provide optimal patient care through, assessment, planning,
implementation, and evaluation of neonatal, pediatric, adolescent,
adult, and geriatric patients and families. This position also
provides information such as certified LOS and reimbursement issues
to physicians as needed to ensure the appropriate and timely
disposition of the client to the next level of care. The Case
Manager monitors and documents the progress of the plan, making
revisions as needed, to assure a smooth transition to the next
level of care at the time of discharge.
Specifics of Positions:
- Excellent documentation and communication skills and must be
able to use critical thinking, find solutions quickly and be
comfortable escalating when services or care are not delivered
efficiently or appropriately.
- Attending rounds and ensure:
- All orders written
- DC plan is in place and in computer
- Social Workers are assigned to appropriate patients
- Choice forms (When needed) and IMMs are signed 48 hours prior
- All are in agreement with DC plan, date of DC and plan for care
- Review charts and ensure
- All orders are written and signed and follow up with physicians
(Hospitalist, UNR, Surgeons)
- Face to Face documentation is done
- DC summaries are written and in system in time for DC
- Ensure all tests are scheduled timely and escalate as
- LOS does not extend beyond what Bed Day Management review
states is appropriate and ensures everyone on care team is working
to DC timely Clinically Complex Cases are worked up appropriately
for DC needs (wound vac, IV meds, Meds Requiring Pre Approval
- The Case Manager must respect beliefs and values while
advocating for the client's right to self-determination and to make
- The Case Manager documents all chart and phone reviews,
identifies and communicates potentially avoidable/non-reimbursed
days, quality indicators (such as re-admissions) and core measures.
As indicated, delivers non-coverage letters as set forth by payer
and/or regulatory compliance.
- The Case Manager acquires and maintains knowledge and
competencies related to the expectations of their position
including an extensive knowledge of post-acute admission criteria
(Rehab, LTAC and SNF etc.). Practice is aligned with the mission,
vision and goals of the Integrated Health System. She/he
participates in Quality Improvement initiatives.
This position does not provide patient care.
The foregoing description is not intended and should not be
construed to be an exhaustive list of all responsibilities, skills
and efforts or work conditions associated with the job. It is
intended to be an accurate reflection of the general nature and
level of the job.
Minimum Qualifications Requirements - Required and/or Preferred
Education: Must have working-level knowledge of the English
language, including reading, writing and speaking English.
Appropriate education to obtain and maintain State of Nevada
Registered Nurse licensure. Bachelor of Science in Nursing
Experience: One year experience preferred as an RN. Case
Management, Post-Acute experience and/or UR/QA experience
License(s): Ability to obtain and maintain a State of Nevada
Registered Nurse license
Certification(s): National Certification (i.e. Case Management
(CCM), Professional Utilization Reviewer (CPUR), or Managed Care
(NMCC)) preferred. Current BLS/CPR certification required.
Computer / Typing: Must be proficient with Microsoft Office Suite,
including Outlook, PowerPoint, Excel and Word and have the ability
to use the computer to complete online learning requirements for
job-specific competencies, access online forms and policies,
complete online benefits enrollment, etc.
Keywords: Renown Health, Reno , RN Case Manager, Healthcare , Reno, Nevada
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