Care Manager, RN

Job Requirements

• Collaborates with the physician and other healthcare professionals to promote appropriate use of medical center resources.
• Participates as a team member to facilitate communication among all disciplines, identify barriers to meeting treatment goals, and determine ways to achieve best outcomes.
• Participates in the hospital Ethics Committee, as well as facilitates the hospital UR committee.
• Uses established criteria to determine appropriateness of admissions, transfer and continued stays.
• Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/ agencies adhering to legal mandates regarding confidentiality.
• Makes measurements of effectiveness of interventions through direct communication with patients and caregivers and data collection of defined indicators (e.g. overall length of stay, readmission rates, feedback from referral services, etc.).
• Uses severity of illness/intensity of services indexes to determine appropriateness of admissions, transfers and continued stays.
• Provides physicians and ancillary departments with data on treatment outcomes and avoidable delays in order to promote highest quality care.
• Identifies potential areas of compliance vulnerability and risk; develops and implements corrective action plans for resolution of problematic issues; and provides general guidance on how to avoid or deal with similar situations in the future.
• Plays and active leadership role in the ongoing management of inpatient length of stay and utilization review across the organization.
• Identifies problems or gaps in community resources that impact outcome and takes leadership role in efforts to effect changes.
• Takes a leadership role in identifying opportunities to reduce risks, both financial and clinical, through analysis of resource consumption outcomes.

Work Experience

• 2 - 4 years Familiarity with health care reimbursement systems (Required)
• 4 - 6 years Acute care hospital or similar venue (Required)
• 2 - 4 years Case management, discharge planning or utilization management (Preferred)

Education

• 2 year / Associate's Degree (Required)
• High School Diploma or GED (Required)
• 4 year / Bachelor's Degree (Preferred)

Certification / Licensure / Registration

• State Registered Nurse License (Required)
• CCM Case Management Certification (Preferred)