RN, Registered Nurse Care Manager - Health Plan Admin

Summary:

The RN Care Manager (CM) II works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. The CM ensures that the patient is progressing toward desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. The CM plans effectively to meet patient need, manage length of stay and promote efficient utilization of resources to include the facilitation of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement

Responsibilities:

• Coordinates/facilitates patient care progression throughout the continuum
• Implements and monitors the patient’s plan of care to ensure effectiveness and appropriateness of services
• Identifies and escalates system barriers that are impeding diagnostic or treatment progress
• Proactively identifies and resolves delays and obstacles to discharge
• Uses advances conflict resolution skills as necessary to ensure timely resolution of issues
• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting
• Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care
• Manages all aspects of discharge planning for assigned patients
• Provide appropriate interventions which demonstrate knowledge of and sensitivity toward cultural diversity and the religious, developmental, health literacy, and educational backgrounds of the patient population
• Assesses the patient’s formal and informal support system as well as available benefits and/or community resources.
• Meets directly with patient/family to assess needs and develop and individualized care plan in collaboration with the physician
• Ensures and maintains plan consensus from patient/family, physician and payor
• Provide education, information, direction, and support related to patient’s goals of care
• Acts as patient advocate to develop treatment plan and coordinate patient care and to transition patient to the appropriate next level of care
• Demonstrates and promotes respect for the dignity and rights of every patient while adhering to the safety standards and practices of the organization and the nursing profession
• Collaborates with the physician and other health care professionals to promote appropriate use of medical center resources
• Provides information and support to patients and families, helping them access needed resources within the medical center and community
• Actively participates in clinical performance improvement activities involving length of stay, resource utilization, avoidable days, cost per case, and readmissions
• Measures effectiveness of interventions through direct communication with post-acute care providers, patients, and caregivers
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.

Requirements:

• BSN Degree from an accredited nursing program or demonstrated success in CHRISTUS RN Care Manager I position
• Excellent verbal and written communication
• Critical and analytical thinking skills
• Demonstrated clinical competency
• Working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
• Understanding of pre-acute and post-acute levels of care and community resources
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, patients and their families
• Three or more years clinical experience in clinical practice or demonstrated success in CHRISTUS RN Care Manager I position
• Case management and Utilization Review experience preferred
• RN License in state of employment or compact required
• Certification in Case Management or demonstrated success in CHRISTUS RN Care Manager I Position

Work Type:

Full Time

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