RN Case Manager

Louisville, KY | Contract

Post Date: 12/05/2017 Job ID: 403654 Industry: Nursing Pay Rate: DOE

We are currently recruiting for (2) RN Case Managers for a 13-week contract assignment in a large acute care facility.  Hours are Mon-Fri from 8:00a-4:30p.

JOB SUMMARY

Works collaboratively with physicians, staff and other healthcare professionals within his/her Division to coordinate the care and service of selected patient populations across the continuum within the acute care setting.

ESSENTIAL DUTIES

  • Identifies priority patients requiring care management services.
  • Collaborates with the patient, family, physician and other healthcare professionals to perform initial and concurrent patient assessment and referrals / recommendations.
  • Develops individualized care management care plans in collaboration with patient and family to facilitate care and decrease variances.
  • Uses severity of illness/intensity of services indexes to determine appropriateness of admissions, level of care, transfers and continued stays.
  • Advocates for adherence to best practice standards through use of approved guidelines, protocols and order sheets.
  • Works in conjunction with Utilization Management team in communicating and negotiating with commercial payers or other outside agencies in order to obtain needed services for patients and accurate reimbursement for the organization.
  • Identifies opportunities to reduce risks, both financial and clinical.
  • Provides important messages from Medicare letters to patients prior to discharge.
  • Prepares and provides letters per policy.
  • Assesses need for services through multi-disciplinary rounds on patients and collaboration with physicians and other inter-
    disciplinary team members.
  • Oversees implementation of transition plans with support from internal and external agents.
  • Monitors patients' progress and adequacy of planning process through regular communication with patients and service providers.
  • Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/agencies adhering to legal mandates about confidentiality.
  • Monitors and measures effectiveness of care plan interventions through direct communication with patients and caregivers
    and review with department leadership of defined indicators (e.g., overall length of stay, readmission rates, feedback from
    referral sources, etc.).
  • Identifies barriers or gaps in community resources that impact outcomes and discharge.
  • Ensures effective hand-offs for discharge home or sub-acute care.
  • Provides backup support for Utilization Management.

EDUCATION / EXPERIENCE / SKILLS: 

  • Current unrestricted license, as a registered nurse in KY.
  • Bachelor of Science in Nursing required; Masters of Science in Nursing preferred.
  • Case Management certification (CCM or ACM) preferred.
  • Basic Life Support (BLS) for the Healthcare Provider certified.
  • Minimum 3 years clinical experience as Registered Nurse (RN) required.
  • Minimum 5 years care management experience preferred.
  • Demonstrated experience in case management, discharge planning, and transfer coordination.
  • Experience with Indicia (formally Milliman Care Guidelines) authorization criteria preferred.
  • Must have excellent computer skills and ability to learn new systems.
  • Must have strong organizational (time management) skills, strong interpersonal skills, the ability to handle multiple priorities with strong attention to detail.
  • Knowledge of and practical use of good business English, spelling, arithmetic, practices.
  • Ability to communicate effectively using written and verbal skills.
  • Proficient in email communications and internet usage along with basic use of Microsoft Excel and Word.
  • Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost).
  • Ability to work autonomously within matrix environment without direct supervision or support.

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3430 Newburg Road, Suite 160 Louisville, KY 40218
Phone: 502-454-5250    Fax: 502-454-5272

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