RN - Case Management

  • Capital Medical Center
  • Olympia, WA
  • Jan 05, 2021
Administration/Operations Nursing

Job Description

The Registered Nurse Case Manager is responsible for facilitating the navigation of patients through their episode of hospitalization. Position Qualifications: 1. Ability to meet minimum hospital hiring standards. 2. Associate’s Nursing Degree Required (Bachelor’s Degree preferred) or Master’s degree in Social Work 3. WA State Registered Nurse License 4. AHA Healthcare BLS 5. 1-3 years experience preferred


1. Ability to meet minimum hospital hiring standards. 2. Associate’s Nursing Degree Required (Bachelor’s Degree preferred) or Master’s degree in Social Work 3. WA State Registered Nurse License 4. AHA Healthcare BLS 5. 1-3 years experience preferred Essential Job Functions*: 1. Performs psychosocial assessment to include pre-hospital level of functioning, brief patient history, identification of support networks, and identification of problems and needs. Demonstrates working theoretical knowledge of human behavior and age-specific development. Analyzes physical, social, psychological, environmental, financial, cultural and spiritual factors of the patient’s present status. Demonstrates working knowledge of crisis intervention theory. Identifies and complies with medical/legal reporting situations (i.e., child abuse, elder abuse, guardianship petitions, and psychiatric commitments). 2. Develops treatment plans responsive to the above analysis and clinical impressions which are appropriate for the patients/family age related development. Identifies and coordinates patient with increased risk factors, such as risk for fall, errors, injury, multiple system failure, multiple physician management, potential discharge planning complications, suicide, depression, and chemical dependency. Ensures that patient/family/significant other expresses understanding of discharge plan. Coordinates care provided in conjunction with therapies directed by other disciplines. Charts are reviewed within 24 working hours of admission and every day for preparation of discharge. Patient is discharged/transferred to appropriate level of care when medically ready. Develops strategies to improve system efficiencies and physician practice patterns. Demonstrates skills as advocate, bargainer, facilitator, mediator and problem-solver. 3. Written assessments reflect relevant information abstracted from the above analysis. 4. Participates in the hospital admission system to coordinate patient required level of care. Facilitates placement of patients in different phases of the healthcare delivery system. Ensures that hospital admissions are appropriate according to InterQual criteria. Arranges for change in admission status with primary physician and/or UM Physician advisor when patient is not at the correct level. Develops strategies to improve system efficiencies and physician practice patterns. Works with coders to ensure the appropriate documentation is present and that any changes are communicated to all parties. Maintains and understanding of plan benefits and conditions of participation. Know the rules and the impacts of transfer DRGs on LOS and reimbursement. Knows InterQual rules and guidelines and uses this criteria to educate and communicate with physicians. Works closely with assigned physician (s). Demonstrates knowledge of and properly utilizes and develops an internal and external resource network. Ensures LOS management, readmission reduction, and efficient utilization of resources. 5. Coordinates and documents patient, family, physician and staff education needs. Identifies Core Measure DRGs on day 1 to ensure that we are tracking these patients. Quality indicators representing care and outcome criteria are collected and reported to Quality Management. Medical staff receives reports and assistance to review identified quality problems and ensure action is taken when needed. Directs patient with complaint to the appropriate supervisor or Administrative Representative, and the Nurse Manager. Patient related complaints/concerns are addressed promptly. 6. Works with other employees in the department to determine the information management needs for the department. Actively participates in action plans to meet the identified needs. Attends annual in-service updates and abides by hospital and department policies regarding prevention and control of the spread of infection. 7. Demonstrates working knowledge of medical terminology, acute and chronic illness, impact of illness upon the person and his/her social systems and impact on length of stay. Interacts with quality improvement while facilitating efficient management of hospital resources. Demonstrates commitment to one’s own professional growth by developing self-evaluation skills and seeking peer evaluations/feedback. Accepts personal accountability for own professional development. Assumes the responsibility for clinical competency and professional development. Contributes to the professional development of peers / colleagues and others. Actively seeks knowledge and skills appropriate to the practice setting. 8. Average length of stay (LOS) will be maintained at or below budgeted number of days. Strategies to reduce LOS and resources consumption are explored and steps taken to implement. Collaborates with HIM for DRG maximization and reimbursement. Collaboration with HIM coder to determine appropriate DRG. Information is given to physicians to improve DRG documentation. Assists with concurrent coding program. Insurance verification and limitations are communicated with the attending physician. 9. Emergency Department Information Exchange (EDIE): identify, assess and manage patients triggered on the EDIE program. Monitor and develop care plans for patients in the EDIE system. Coordinate and update the EDIE system assuring that patient’s information is correct based on assessments completed. 10. Work with physicians and providers in the ED to assure appropriate level of care assigned at the time of admission. Coordinate and document ED patients utilization criteria in electronic health record at the time of admission. 11. Assess and monitor documentation on patients in ambulatory surgery to assure appropriate status order is in place prior to patient’s procedure and admission to the floor. Essential Physical, Mental and/or Environmental Working Conditions: 1. Must be able to meet the physical/mental demands of position with or without accommodation. See checklist (page 2) for specific physical, mental and environmental working conditions. 2. Must be able to utilize good judgment, demonstrate patience, and maintain a professional demeanor at all times. 3. Must be able to work in a busy and stressful environment.

Employment Type (feed only)