RN Care Management - Per Diem

PeaceHealth is seeking candidates for a Per Diem Care Management RN position at Sacred Heart Medical Center at Riverbend in Springfield, Oregon. This role coordinates and facilitates the discharge plan of care and service for selected patient populations across the continuum of illness, promotes effective utilization and monitoring of health care resources, and assumes a leadership role within the interdisciplinary team to achieve optimal clinical, financial, and satisfaction outcomes.

About the role

In this per diem position, you will work variable day shifts, typically 8 or 10-hour shifts. You will act as an intermediary between the hospital and third-party payors to ensure patients receive appropriate medical services and the organization receives optimal reimbursement, in accordance with regulatory standards.

Responsibilities

• Reviews patient admission data within established timeframes to determine the appropriate level of care in accordance with hospital-sanctioned industry standard criteria.
• Assesses, develops, implements, and monitors a comprehensive discharge plan of care through an interdisciplinary team process in conjunction with the patient and family.
• Comprehensively assesses patients’ goals as well as their biophysical, psychosocial, environmental, 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 with members of the interdisciplinary team to ensure hospital and community resources are appropriately 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 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.
• Communicates within designated time frames with third-party payors to obtain authorizations and resolve payment issues on behalf of patients, families, and the organization.
• May assume Palliative Care responsibilities, including facilitating and coordinating pain and symptom management, POLST, family meetings, and comfort care.
• Performs other duties as assigned.

Requirements

• Graduate of an Accredited School of Nursing (Required). BSN or MSN preferred.
• Minimum of 3 years of clinical nursing experience in an acute care hospital or equivalent skilled nursing facility, outpatient case management, home health, or hospice experience.
• RN care management experience (Required).
• Utilization management/quality management experience (Preferred).
• Active Oregon Registered Nurse License (Required).
• Basic Life Support Certification (Required).
• Specialty Certification (Preferred).

Skills

• Third-party reimbursement knowledge (Preferred).
• Interpersonal skills to obtain and interpret information appropriate to patients’ needs and age as required for assessment, 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 a 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 the 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

The salary range for this job opening is $50.78 – $79.78 per hour. The hiring rate is dependent upon several factors, including but not limited to education, RN work experience, and terms of the Oregon Nurses Association collective bargaining agreement.

Benefits

• An additional 15% per diem differential.
• Additional compensation for BSN, MSN, and specialty nursing certification.
• A Professional Nurse Advancement Program with pay incentives.
• Continuing Education, a wellness program, and more.
• For positions less than 0.5 FTE: 403b retirement plan for caregiver contributions, wellness benefits, discount program, and expanded EAP and mental health program.