Care Manager RN

at  Providence Swedish

REQUIRED QUALIFICATIONS:

• Bachelor’s Degree: Graduate of an accredited Bachelors Nursing degree program or completion of an accredited Nursing program with a Bachelors degree or higher in a health care field or
• Applicants without a BSN degree must actively pursue and attain a BSN within three years of hire. Continued employment by Swedish beyond three years is contingent upon attaining the BSN degree
• Washington Registered Nurse License upon hire
• 3 years registered nursing experience in an acute care hospital

PREFERRED QUALIFICATIONS:

• 1 year hospital case management experience

• Acts as resource and provides oversight for the Case Management Associate for discharge planning and utilization activities
• Coordination: Integrates the work of the healthcare team by coordinating resources and services necessary to accomplish agreed-upon goals.
• Comprehensively assess patients’ goals as well as their biophysical, psychosocial, environmental, economic/financial, and discharge planning needs.
• Procures services and resources for identified patients and families, serving as an advocate to promote achievement of agreed-upon goals.
• Advocacy: Advocates on behalf of patients and caregivers for service access or creation, and for the protection of the patient’s health, safety and rights.
• Advocates for the patient, family, physician, and facility to obtain benefits from insurance carriers and others that provide financial assistance for patients and promote health care treatment goals.
• Identifies and reports cases and problems appropriate for secondary review to Case Management Department leadership, the Medical Director, or Physician Advisor.
• Resource Management; Assures prudent utilization of all resources (fiscal, human, environmental, equipment and services) by evaluating the options available and balancing cost and quality to assure the optimal clinical and financial outcomes.
• Assesses the appropriateness and timeliness of level of care, diagnostic testing and clinical procedures, quality and clinical risk issues, and documentation completeness.
• Maintains and documents third-party payers’ authorizations, contacts, and transactions for individual patients.
• Accountability: Accepts responsibility and accountability for achievement of optimal outcomes within their scope of practice.
• Seeks out information and resources and uses creative problem solving for complex discharge planning, quality of care, and utilization issues. Explores new resources when the opportunities for the patient are absent or in short supply.
• Continually evaluates case management services and client outcomes.
• Professionalism: Acquires and maintains knowledge and competence related to the expectations of their position and practices within their scope.
• Studies information available to remain informed of reimbursement modalities, community resources, review systems, and clinical and legal issues that affect patients and providers of care.
• Serves as a resource and provides education to patients, physicians, and professional staff on levels of care, quality-of-care issues, and regulatory concerns.
• Provides orientation and mentoring to new staff.
• Works in accordance with applicable state and federal laws and with the unique requirements of reimbursement systems.
• Is knowledgeable about and acts in accordance with laws and procedures regarding patient confidentiality and release of information, Americans with Disabilities Act, other laws protecting rights, and worker’s compensation laws when applicable to the case manager’s practice.
• Performs other duties requested by the department leadership.