RN Care Management

About the Role

Coordinates and facilitates the discharge plan of care and services for selected patient populations across the continuum of illness. Promotes effective utilization and monitoring of health care resources, and assumes a leadership role with the interdisciplinary team to achieve optimal clinical, financial, and satisfaction outcomes. Acts as intermediary between hospital and third-party payors to ensure patients receive appropriate medical services, and the organization receives appropriate and optimal reimbursement, in accordance with regulatory standards.

This is a full-time, 0.8 FTE day shift position working four 8-hour shifts each week at a 350-bed acute care medical center with a level II trauma center.

Responsibilities

• Reviews patient admission data within established timeframes to determine the appropriate level of care in accordance with hospital-sanctioned industry standard criteria and/or other established criteria for other settings across the continuum of care.
• Assesses, develops, implements, and monitors a comprehensive discharge plan of care through an interdisciplinary team process in conjunction with the patient and family in internal and external settings.
• Comprehensively assesses patients’ goals as well as their biophysical, psychosocial, environmental, and discharge planning needs and financial status.
• Identifies key problems, strengths, and resources to be addressed in the discharge plan of care, including needed resources post-discharge, and coordinates those services.
• Ensures accurate documentation for patient’s continued hospital stay is established and maintained; coordinates necessary changes with attending physician and other team members to achieve optimal care and reimbursement.
• Communicates proactively and adeptly with members of the interdisciplinary team to ensure hospital and community resources are appropriately and effectively utilized on behalf of patients and their families.
• Facilitates interdisciplinary team meetings to improve quality, decrease cost, and improve patient satisfaction.
• Coordinates documentation and clarifies necessary details with Patient Financial Services to assist in decreasing denials.
• Ensures completion of documentation necessary for utilization assessments and communicates via electronic medical record information needed to justify continued hospitalization. Maintains any applicable care management databases.
• Performs concurrent review to determine correct admission status per insurance criteria, including Interqual or other industry standard criteria recognized by Medicare. Monitors and documents variance days, communicates with attending physician and UR Physician Advisor as indicated, and documents outcomes in appropriate locations.
• Communicates within designated time frames with third-party payors to obtain authorizations and resolve payment issues on behalf of patients, families, and the organization if applicable.
• May assume Palliative Care responsibilities as indicated, including facilitating and coordinating pain and symptom management, POLST, family meetings, and comfort care.
• Performs other duties as assigned.

Requirements

• Accredited School of Nursing
• Minimum of 3 years RN experience in an acute care hospital (equivalent skilled nursing facility, outpatient case management, home health, or hospice experience may be considered)
• Oregon RN license
• Basic Life Support Certification

Preferred Qualifications

• Case Management certification
• Utilization management/quality management experience
• BSN or MSN

Skills

• Third-party reimbursement knowledge (Preferred)
• Interpersonal skills to obtain and interpret information appropriate to patients’ needs and age as required for assessment, range of treatment, and patient care (Required)
• Skill and proficiency in applying highly technical principles, concepts, and techniques, typically acquired through completion of a bachelor’s degree in nursing (Preferred)
• Demonstrated ability to promote positive interpersonal relationships and patient/family-centered work environment (Required)
• Basic computer skills including MS Office applications (Required)
• Effective prioritization skills (Required)

Working Conditions

• Lifting: Patient handling no greater than 35 lbs. without the use of assistive equipment and/or devices (NIOSH).
• Fine motor skills to grasp and control medical equipment and perform precise procedures.
• Push/Pull: Frequently up to 45 lbs. force (e.g., WOW, medical carts).
• Perform hands-on CPR for at least 20 minutes using 100-125 lbs. of force (National Assoc. of EMS Physicians and AHA). Frequency should be seldom or occasionally.
• Ability to move around area with frequent sitting.
• Bending, stooping, squatting, reaching, and kneeling frequently.
• Lifting (non-patient) up to 20 lbs. occasionally and 5 lbs. frequently.
• Exposure to biohazard, body fluids, and airborne particles.
• Must be able to complete tasks in a noisy environment.
• Vision and hearing required within normal limits (glasses, contacts, hearing aids permitted).
• Ability to communicate and exchange accurate information.

Pay

A current wage range of $50.78 - $79.78 per hour, dependent upon RN experience and terms of the Oregon Nurses Association union contract. Additional compensation for BSN (4%), MSN (5%), and Specialty Nursing Certification ($3.75).

Benefits

• Great shift differentials and weekend differential
• Professional Nurse Advancement Program with pay incentives
• Relocation Assistance and Hiring Bonus
• Full benefits package effective the first of the month following start date
• Excellent Tuition Assistance and Continuing Education (CE) reimbursement
• 403b retirement plan with employer base and matching contributions
• Employer-paid life and disability insurance with additional buy-up coverage options
• Paid time off
• Wellness benefits and expanded EAP and mental health program

Location

This role is based in Springfield/Eugene, Oregon, offering:

• Access to incredible outdoor recreation, including forests, rivers, mountains, and scenic trails. Easy access to hiking, biking, fishing, kayaking, camping, and skiing. Just an hour from the Cascade Mountains and the Oregon Coast.
• Nationally recognized bike-friendly community with extensive trail systems, parks, and outdoor fitness opportunities. Mild climate allows for year-round outdoor activities.
• Family-friendly neighborhoods with a college-town energy, home to the University of Oregon. Vibrant arts, culture, sports, and educational opportunities.
• Convenient location less than two hours from Portland, with easy access to mountains, beaches, and other Northwest destinations. Eugene Airport offers regional connections.