Registered Nurse Case Manager

Employment Type: Full time Shift: Day Shift Description: At Mercy One, health care is more than just a doctor’s visit or a place to go when you’re in need of medical attention. Our Mission is based on improving the health of our communities – that means not only when you are sick but keeping you well.

Mercy One Dyersville Medical Center is a 20-bed critical access hospital serving 17 rural communities in western Dubuque County, offering the following services:
Emergency/Trauma, Acute and Skilled Care, Rehabilitation Services (PT/OT/Speech), Ambulatory Surgery, Home Care, and Specialty Clinics. Mercy One is committed to providing quality, personalized and safe health care close to home.

The Case Manager coordinates care across an episode and/or the continuum for clients with complex problems and diverse needs. The Case Manager’s focus is to maintain patients at an optimal level of health and to support self‑care. Case Managers collaborate with physicians, social services, nurses, and community agencies to define care options and resources, to plan cost‑effective quality care and to achieve optimal outcomes.

Specific responsibilities include case screening, insurance approval, assurance of timely services, and facilitation of discharge with transition to the appropriate services. Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines. Works proactively to coordinate the services of physicians, nurses, and other disciplines to effectively prepare patients for discharge.

The Case Manager facilitates program development, efficient care delivery processes and quality improvement including tracking of resource utilization and outcome measures. The Case Manager is accountable for improving service using cost and quality outcome data, current clinical practices and related research, regulatory requirements and comparative benchmark opportunities.

Customers include patients, families/visitors, physicians, physician assistants, nurse practitioners, case managers, representatives of third‑party payers, representatives of referring agencies, interdepartmental and intradepartmental staff, vendors, and volunteers.

Actively knows, understands, incorporates, and demonstrates the organization’s mission and core values, including the Guiding Behaviors and Caring Model Principles, and always conducts oneself in a manner consistent with these values.

Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior.

• Demonstrates knowledge, skills and abilities to provide case management services appropriate to the age of patients served.
• Exhibits sound judgment, critical thinking, problem solving and decision‑making skills.
• Communicates effectively with patients, significant others, and members of the health care team.
• Compiles information; keeps records, prepares or directs preparation of reports and correspondence.
• Executes daily utilization functions for assigned patients, including prior authorization, admission, precertification/certification/recertification, concurrent and retrospective review, associated analysis, and referral appropriateness.
• Participates in comprehensive team meetings and conferences regarding specific patient needs that affect cost, quality, and length of stay. Demonstrates ability to promote collaboration and creativity among members of the health care team.
• Responsible for assuring thorough case management assessment, as well as early and ongoing discharge plans by collaborating with patients, families, physician, payors, and providers across the continuum of care.
• Reports potential catastrophic and high‑cost cases to department director, nursing director, and finance department for appropriate medical/administrative review and management.
• Effectively manages length…