Registered Nurse Care Manager - HP Utilization Management

Responsibilities

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.

• 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.

Job

Requirements

Education/Skills

• BSN Degree from an accredited nursing program or demonstrated success in CHRISTUS RN Care Manager I position required.

• Master’s degree in nursing preferred.

• Program management experience, including management of multiple projects at one time preferred.

• 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.

Experience

• 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.

Licenses, Registrations, or Certifications

• RN License in state of employment or compact required.

• Certification in Case Management or demonstrated success in CHRISTUS RN Care Manager I Position preferred.

Work

Schedule

5 Days - 8 Hours

Work Type

Full Time