Hospice Case Manager RN

Overview

The Care Management RN conducts audits and evaluation of patient records and will use professional clinical skills to evaluate opportunities to optimize clinical resource management, utilization of services, and length of stay to ensure patients receive quality, cost effective care and to maximize patient outcomes in alignment with agency and industry standards and financial metrics.

Providence at Home with Compassus

The Care Management RN conducts audits and evaluation of patient records and will use professional clinical skills to evaluate opportunities to optimize clinical resource management, utilization of services, and length of stay to ensure our patients receive quality, cost effective care and to maximize patient outcomes in alignment with agency and industry standards and financial metrics. The management of resources and the coordination of the continuum of care will be performed in a manner consistent with the mission, vision, and core values of Providence St.

Joseph Health.

• Assessment:
  The Care Management RN will assess the patient’s clinical condition and appropriateness of the requested services based on the documentation in the medical record and the organization’s approved utilization review guidelines.
• Planning:
  Collaborates with Director, Clinical Managers and other members of the interdisciplinary healthcare team to ensure documentation supports medical necessity and appropriateness of planned treatments and services.
• Implementation:
  Will complete reviews timely, document in the appropriate electronic medical record, and maintain files according to department standards and policy and procedures using principles of appropriate utilization review and evidence of coverage guidelines.
• In conjunction with Director and Clinical Managers participates in ongoing staff education regarding utilization guidelines, documentation of medical necessity, clinical appropriateness of services provided.
• Coordination:
  Interacts with other members of the interdisciplinary team and other Departments and Programs as needed.
• Escalates cases for review to Clinical Manager and Director as appropriate.
• Monitoring:
  Will develop and participate in appropriate studies, audits and/or surveys to provide appropriate and measurable outcomes to Quality Management Team.
• Communication:
  Fosters cordial, positive and professional interpersonal relationships with members of the healthcare team, community agencies and peers.
• Develops high level negotiating skill to effectively work with all members of the healthcare team in order to maximize utilization, quality, and service.
• Identifies other issues that may affect patient care, impact utilization of services or lead to increased length of stay (insufficient medical record documentation, lack of timely test or treatment, etc.), and communicates findings to the appropriate Clinical Manager and Director.

• Required - Coursework/Training Graduate of an accredited school of nursing.
• Preferred - Bachelor’s Degree in Nursing.
• Required - 1 year Experience as an RN in a Home Health and/or Hospice setting.
• Preferred - Utilization review/quality management performance improvement experience.

• Mathematical
  
  Skills:
  
  Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage.
• Language
  
  Skills:
  
  Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders, team members, investors, and external parties. Strong written and verbal communications.
• Language
  
  Skills:
  
  Ability to understand, read, write, and speak English. Articulates and embraces integrated healthcare at home philosophy.
• Computer
  
  Skills:
  
  Intermediate computer skills including knowledge of basic computer software programs.
• Computer
  
  Skills:
  
  Basic computer skills including Windows, Microsoft Word,…