Registered Nurse Care Manager - Pediatric Rheumatology

Collaborates with other members of the health care team to ensure the above according to the mission of CHRISTUS Santa Rosa Health Care.

*Responsibiliteis*

• Key driver of throughput process by safe discharge plan
• Daily monitors LOS compared to GMLOS on each patient for reduction in opportunity days to reach LOS ratioLOS: Impacts Medicare GMLOS by managing per Milliman/Interqual Care Guidelines.
• Resource/Utilization Management/appropriateness: Assess assigned patient population for medical necessity, level of care and appropriateness of setting and services. Utilizes Milliman/Interqual Care Guidelines to track impact and variance.
• Discharge Planning: Collaborates with Social Worker proactively - arranges to meet facilities' target Discharge Time. Initiates NaviHealth search for PAN refferrals.
• Proactively uses 3M report which assigns working MS/APR DRG in MIDAS daily, and queries, communicates and collaborates with nursing, physicians, and other healthcare professionals daily related to length of stay (LOS).
• Adheres to MCG process for documentation per training
• Documents delays of care and readmits appropriately and timely to develop potential trends and improved interventions.
• Payer Initiatives: Reconciles services available and rendered with patient benefit allowances to assure reimbursement and minimize financial losses for patient and hospital.
• Proactively refers cases to physician adviser for P2P, medical necessity review, and denail avoidance.
• Demonstrates and maintains current knowledge of regulatory agencies' relative to work process for compliance, i.e. IMM, Code 44
• Timely communication with Admitting for status changes to ensure proper payer notification.
• Attends and actively participates in interdisciplinary patient care rounds on a daily basis and works with the health care team to collaboratively formulate appropriate and realistic discharge plans.
• Guest Relations/Communications: Demonstrates positive role modeling of customer relations (customers include patient, physicians, other health care team members, payers, etc.). Uses AIDET and KWKT appropriately.
• Quality/Outcomes Management: Identify and assist outcomes management process by referring and reporting variances in standards of care for identified patient populations.
• Change Management: Acts as a catalyst for change in the organization; responds to change with flexibility and adaptability to overcome organizational resistance and inertia; demonstrates the ability to focus and energize associates to work together for change; gains maximum support form others for new initiatives.
• Shaping the Organization: Devises systems and processes which improve the overall functioning of the organization; ensures that the organization’s systems, processes and people are integrated to achieve the mission in the most efficient and effective manner.
• Achieving Results: Demonstrates the confidence, drive and ability to face and overcome challenges and obstacles to achieve organizational goals.
• Enhancing Clinical Outcomes: Works to improve the healthcare process in general and devises and implements strategies specifically directed at improving clinical outcomes.
• Utilizes licensed evidenced-based tools (MCG / Interqual) to analyze and identify trends/patterns of performance through variance reporting to improve quality, satisfaction, and decrease cost variation.
• Age/cultural specific implications: Appropriately adapts assigned assessment, treatment and/or service methods to accommodate the unique physical, psychological, cultural, age-specific and other developmental needs of each member served.
• Core Values: Demonstrates adherence to the CORE values of Santa Rosa Health Care.
• Some weekend work and work after normal business hours may be required, as needed, to meet the needs of the facility and our patients.
• Performs other duties as directed.

*Requirements*

• Graduate of an accredited school of Nursing required. BSN preferred.
• Proficient word processing skills in a Windows environment required.
• Ability to analyze and create reports and presentations via software applications.
• Familiarity with MIDAS and Meditech systems preferred. Bilingual (English/Spanish)preferred.
• A minimum of 5 years in clinical practice for population to be served is required.
• Case Management/Resource Management and discharge planning experience preferred.
• Milliman (MCG) Guideline and Interqual criteria experience highly preferred.
• Currently licensed as RN in the State of Texas required
• CPR optional
• Certification in Case Management preferred

*Work Schedule*

5 Days - 8 Hours

*Work Type:*

Full Time

Pay: $31.00 - $53.00 per hour

Benefits

• 403(b)
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Free parking
• Health insurance
• Health savings account
• Life insurance
• Mileage reimbursement
• Paid time off
• Parental leave
• Referral program
• Relocation assistance
• Tuition reimbursement
• Vision insurance
• Wellness program

Work Location: In person