Registered Nurse Case Manager (RN)

Job Description

The individual’s responsibilities include the following activities:

• accurate medical necessity screening and submission for Physician Advisor review,
• care coordination,
• transition planning assessment and reassessment,
• implementation or oversight of implementation of the transition plan,
• leading and facilitating multi-disciplinary patient care conferences,
• managing concurrent disputes,
• making appropriate referrals to other departments,
• identifying and referring complex patients to Social Work Services,
• communicating with patients and families about the plan of care,
• collaborating with physicians, office staff and ancillary departments,
• leading and facilitating Complex Case Review,
• assuring patient education is completed to support post-acute needs,
• timely complete and concise documentation in Case Management system,
• maintenance of accurate patient demographic and insurance information,
• identification and documentation of potentially avoidable days,
• identification and reporting over and underutilization,
• and other duties as assigned.

Qualifications

• Education: Graduate of an accredited school of nursing
• Experience: 2 years of acute hospital patient care experience
• Certifications: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered.
• PREFERRED: Academic degree in nursing (bachelor's or master's)
• PREFERRED: Accredited Case Manager (ACM)

Benefits

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

About the Role

This position may qualify for a sign-on bonus.

The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge, and prevent avoidable readmissions. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention, and patient satisfaction; Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care; Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy; Education provided to physicians, patients, families and caregivers.

Success Profile

• Innovative
• Advocate
• Collaborative
• Person-Centered
• Resourceful
• Critical Thinker

Organization Description

We help people achieve health for life through compassionate service inspired by faith. Since the early 1920s, Valley Baptist Medical Center hospitals have been involved in the community, caring for the health and spiritual needs of people in the Rio Grande Valley. We are dedicated to continuing our strong tradition of providing quality, compassionate healthcare that puts people first. Our mission is to serve, heal and educate with concern for the whole patient, an understanding of the economic environment and a relentless commitment to quality. Join our team!

Employment Practices

Our employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status.

Our Competitive Benefits

• Learning and Education: Our online learning platform provides access to thousands of free courses to help you further your education – on your schedule.
• Graduate Medical Education Programs: We offer more than 100 residencies and fellowships within our GME programs, where you can gain more experience on treating the full range of diseases within your specialty.
• Leadership and Executive Development: Wherever you are in your career, our development programs are designed to take your professional growth to the next level.
• Coaching and Mentorship: You’ll have open dialogues between your supervisors and team members to continue developing your skills and leave a large impact on care.
• Military and Veterans Support: Through our skill and experience equivalency mapping, we can help you translate your skills learned in the military toward a successful civilian career. Learn more here.
• Healthcare Scholarships: We're invested in raising the next generation of health professionals, opening doors to more scholarships to help advance education for all.

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