RN Case Manager

Beloit Health System is looking to add an RN Case Manager to our Care Coordination Team!

• Shift: 1st

• Schedule: 8a - 4:30p

• Hours per week: 40

• Benefits Status: Eligible

• Department: Care Coordination

The RN Case Manager (CM) will complete utilization review responsibilities and assist with coordinating the patient transition of care from admission to discharge. The patient population will include those with complex medical conditions, and/or social-economic and mental health co-morbidities. The CM will be an active member of the collaborative team consisting of the patient, nurses, social workers, physicians, other providers, family, and caregivers. The CM goal is to ensure quality, timely, and cost-effective care of the patient during their hospitalization.

• Assist with assessing the physical, functional, social, psychological, environmental, learning and financial needs of the patient as appropriate. 
• Identify problems, goals and interventions to meet the patient's needs.
• Provide appropriate interventions which demonstrate knowledge of and sensitivity toward cultural diversity and religious, developmental, health literacy, and educational backgrounds of the population served.
• Evaluate patient's progress toward discharge goal including identification and evaluation of barriers to meeting or complying with plan of care.
• Participates in multi-disciplinary discharge rounds and care conferences to ensure appropriate and timely discharge of patients. Effectively communicates to the comprehensive care team the level of care needed based on medical necessity using hospital approved guidelines.
• Provide education, information, direction, and support related to patient care goals and discharge plan.
• Identify patients that are at risk for readmission and work with the care team to ensure patient needs and follow-up care is in place to minimize the potential for readmission. Work with the transition of care nurse to follow patients identified as high risk for readmission for 30 days post discharge
• Act as a patient advocate and assist with problem solving and addressing any barriers to care or compliance with care plan.
• Coordinate care and treatment plans between providers.
• Facilitate communication between providers and departments as necessary to ensure timely care and cost-effective utilization of resources.
• Determination of appropriate admission status (inpatient, observation, outpatient in a bed) using hospital approved guidelines.
• Concurrent reviews of admissions/observations for monitoring of medical necessity for hospital stay using hospital approved guidelines.
• Discuss with physicians any concerns regarding utilization of services, level of care, medical necessity, LOS, and documentation requirements.
• Consult physician advisor (Director of Hospitalists and department heads) regarding admissions that do not meet hospital approved guidelines/criteria and the admitting or attending physician disagrees.
• Completes initial and continued stay insurance reviews as requested by the payers for certification of coverage.
• Manages denials related to lack of medical necessity as determined by the payer including, but not limited to, setting up Peer to Peer review and written appeals.
• Identifies quality issues and reports to leadership of quality department.
• Participate in prospective, concurrent and retrospective case reviews as requested.
• Use hospital approved guidelines to educate physicians and nursing staff on optimal care for hospital admissions and readmissions.
• Maintain accurate patient records and patient confidentiality. Documentation will meet requirements for audits and QI report needs.
• Identify patient complaints/issues and direct appropriately (Is knowledgeable of HCAHPS survey questions).
• Attend mandatory training sessions and staff meetings as assigned.
• Develop, implement, and evaluate department initiatives and goals as assigned.
• Assist with the collection, analysis, benchmarking and reporting of data.
• Collaborate in the development of policies, protocols, and guidelines for the case management program.
• Promote the case management program to care providers.

Job Requirements

• Current WI RN license
• Minimum of 2 years' acute care hospital experience
• Excellent observation, organizational, verbal and written communication skills
• Ability to solve problems quickly while under time constraints
• Ability to be flexible with schedule to efficiently and effectively manage case load
• CPR Certification within 90 days
• Adheres to established Health System and Care Coordination department policies, rules and regulations.
• Maintains ethical conduct and keeps confidential personal and medical information about patients.
• Reporting Relationship: Director and Manager of Quality, Risk and Care Coordination
• Provides clinical direction to social workers.

BEHAVIOR AND ATTITUDE

The mission of Beloit Health System, Inc. is to be the leader in regional health and wellness services that delivers high quality value and satisfaction to our patients and communities we serve.

Beloit Health System requires the employee to maintain integrity as a fully engaged employee. Each employee will perform in a manner which ensures delivery of the highest quality of medical services and patient satisfaction. Respect and consideration given to the dignity of each patient, visitor, and fellow employee is a requisite of successful job performanc