Registered Nurse - Now Hiring
Company: Integris Health
Posted on: February 25, 2021
RN Case Mgr
Job Code: 1318
The Case Manager is responsible for the clinical and financial
outcomes for an assigned caseload of patients as appropriate. 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. Adheres to National
Patient Safety Goals as appropriate based on the level of patient
contact this position requires.
INTEGRIS is an Equal Opportunity/Affirmative Action Employer. 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.
The RN Case Manager responsibilities include, but are not limited
to, the following:
Completes a comprehensive assessment of patients clinical,
psychological and financial needs utilizing all available
Recommends and coordinates timely transfers to appropriate levels
of care as indicated by clinical needs and utilization
Develops, implements, evaluates and revises, as necessary, a plan
for discharge, including referrals to other health care and
community organizations based on needs assessment.
Communicates discharge care plan, and any changes in the plan to
patient, family and all appropriate healthcare professionals.
Assists physicians and hospital staff in appropriate utilization of
resources through application of utilization criteria and
facilitating timely discharge planning for patients.
Coordinates services between hospital departments to facilitate
timely patient discharge.
Conducts concurrent review of patient records on admission to the
hospital and as determined by the patient's clinical condition.
Applies utilization criteria accurately in order to determine
appropriate utilization of resources.
Notifies designated internal and external contacts of utilization
issues that may affect patient care and/or reimbursement.
Facilitates patient transfers to other health care organizations in
accordance with hospital policies and all-applicable state and
federal guidelines and regulations.
Acts as a resource/advisor to physicians regarding discharge
planning, medical record documentation, and all issues that may
affect resource utilization and reimbursement.
Integrates and manages established pathways, where available, to
enhance clinical effectiveness and clinical resource
Maintains knowledge and understanding of CMS regulations,
Medicare/Medicaid, managed care and other payer regulations and
Acts as a resource and provides education for patients, their
family members and all health care professionals regarding HCFA
regulations, Medicare, Medicaid, managed care and other payers.
Develops and maintains knowledge and understanding of hospital and
community resources, and facilitates use of most appropriate level
of care to conserve patient, hospital, and payer resources.
Identifies opportunities to reduce cost of managing patient care
without impacting quality or outcomes.
Participates in collecting and recording data for utilization and
Quality Improvement reporting.
Works collaboratively and professionally with patients, family
members, and physicians, hospital staff and other individuals and
agencies involved in providing patient care.
Mental Health Only:
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
Provides documentation daily in patients' charts on each group
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
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
Assesses patients for appropriateness of admission to the
INTEGRIS Certified Case Management Only:
Documents and communicates in a timely fashion patients progression
throughout the continuum of care to all necessary parties via
electronic, written, and verbal means.
Apprises team members of challenges encountered throughout the
continuum of care via electronic, written, and verbal means.
Utilizing strong organizational skills, personally manage evolving
calendar of commitments in the best interest of the patient and
Utilizing excellent interpersonal, collaborative, and conflict
resolution skills, act in the capacity of liaison between the
patient, medical provider, and the organization to achieve positive
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 Managers report to the Unit Program Manager
INTEGRIS Certified Case Managers report to the Process Manager,
Jim Thorpe Rehab Hospital: Reports to Mgr Post-Acute Care and
Required Physical Demands (Subject to Reasonable
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
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):
Mental Health staff must be able to assist with physical restraint
of patients, utilizing the Mandt System.
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.
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.
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.
5 years experience in a variety of clinical settings (e,g. home
health, inpatient, physician office, clinic) required.
Experience with managed care and payer/provider requirements
Current licensure as a Registered Nurse (RN) in the State of
Oklahoma or current multistate license from a Nurse Licensure
Compact (eNLC) member state. BSN preferred.
Excellent interpersonal communication and collaboration skills.
Computer experience required. Windows preferred.
Current Case Management Certification preferred, at minimum
attained within one year of hire (INTEGRIS Certified Case
Current Driver's License issued by the state of Oklahoma.
Keywords: Integris Health, Edmond , Registered Nurse - Now Hiring, Healthcare , Kremlin, Oklahoma
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