Billings Clinic RN Care Manager in Billings, Montana
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Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital.Learn more (https://www.billingsclinic.com/about-us/) about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality.
We provide a comprehensive and competitive benefits package to all full-time employees (minimum of 24 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more.Click here (https://www.billingsclinic.com/careers/employee-benefits/) for more information ordownload the 2021 Employee Benefits Guide (https://ncstoragemlbillings.blob.core.windows.net/public/2021%20Billings%20Clinic%20Staff%20Benefits%20Guide.pdf) .
Magnet: Commitment to Nursing Excellence
Billings Clinic is proud to be recognized for nursing excellence as a Magnet®-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years. Click here (https://www.billingsclinic.com/campaign-landing-pages/magnet/) to learn more!
RN Care Manager
Billings Clinic (Billings Clinic Main Campus)
Employment Status: Full-Time (.75 or greater)
Hours per Pay Period: 1.00 = 80 hours (Non-Exempt)
Starting Wage DOE: 28.61
Under the direction of department leadership, the Care Manager provides services consisting of comprehensive care management, care coordination and care continuing care services. The Care Manager is accountable for a designated patient caseload/population and plans effectively in order to meet patient needs. The Care Manager is a support to providers and the multidisciplinary in facilitating patient care. The Care Manager strives to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care.
Essential Job Functions
Knowledge, Skills, and Abilities • Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
Conducts initial and ongoing assessments and chart reviews of each assigned patient to identify potential and or actual barriers and care needs.
Proactively screens and assesses the acuity and transitional needs of each assigned patient.
Engages and collaborates with patients, support systems and the multidisciplinary/healthcare team to establish a plan of care that addresses the mutually identified needs of the patient.
• Interventions and Care Coordination
Demonstrates the ability to interpret clinical information and understand health care treatment and systems.
Supports patients to ensure they can function to the best of their ability and maintain optimal health related to their medical condition(s). Identifies and addresses gaps in knowledge/understanding/education related to disease management.
Participates in the patient’s plan of care by interacting/collaborating with patients, support systems, healthcare professionals and community and state agencies. Serves as a liaison between hospital, clinic and community agencies to facilitate the exchange of clinical and referral information.
Identifies high-risk patients through risk stratification tools and ongoing assessments including ED utilization and hospitalizations to address the medical/psychosocial/financial needs of patients and their support systems in both hospital and ambulatory settings.
Reinforces goals of care and treatment plans with patients and support systems in order to enhance patient and support system engagement.
Coordinates care conferences to support effective communication as needed.
Helps navigate the patient throughout the continuum of care.
Effectively collaborates and coordinates care with the Social Services Care Manager.
Maintains current knowledge of community resources and ancillary clinical services to meet the needs of hospital, clinic and regional customers.
Provides information about available resources to patients and their support systems.
Partners with the multidisciplinary/healthcare team and the Social Services Care Manager to guide/advocate placement to the appropriate Acute rehab, LTACH, SNF, long-term care facility, assisted living facility, or Home Health Care, in-home services, hospice, ancillary OP services and/or DME as clinically appropriate.
Acts as a clinical resource to the Social Services Care Manager.
Understands consultative disciplines and their role in patient care.
Maintains respectful and professional communication skills.
• Insurance and Utilization Management
Maintains working knowledge of CMS requirements and readmission penalties.
Maintains working knowledge of insurance/payer benefits.
Monitors the need for revisions in the plan of care and makes recommendations to the multidisciplinary/healthcare team when indicated. Modifies the plan of care/goals to reflect changes in patient or their support system status and needs.
Monitors, evaluates and documents patient progress related to plan of care.
Documents accurately and in a timely manner in the Electronic Medical Record per program guidelines.
Utilizes standards of professional practice in all documentation and communication consistent with organization/department policy as well as the Board of Nursing and ethical guidelines established and universally supported by the nursing profession.
Documentation and patient information shall be secured and maintained in accordance with Billings Clinic policy, HIPPA, state and federal guidelines.
• Safety/Quality Assurance/Risk Management
Identifies service gaps and participates in hospital and department programs to address and improve quality of care.
Advocates for marginalized or vulnerable populations by identifying cases of abuse and neglect and appropriately involving risk management and regulatory agencies.
• Professional Accountabilities
Participates in continuing education, department planning, work teams and process improvement activities.
Maintains current Licensure.
Adheres to department and organizational policies addressing confidentiality, infection control, patient rights, medical ethics, advance directives, disaster protocols and safety.
Demonstrates the ability to be flexible, open minded and adaptable to change.
Maintains competency in organizational and departmental policies/processes relevant to job performance.
Utilizes standards of professional practice in all communication with patients, support systems and colleagues consistent with the Board of Nursing and ethical guidelines established and universally supported by the nursing profession.
• Performs all other duties as assigned or as needed to meet the needs of the department/organization.
• Inpatient Care Management Specific
Collaborates with post-acute services, Ambulatory Care Managers and PCP’s to ensure successful transition back to the home environment. Makes appropriate Ambulatory Care Management referrals. Anticipates those patients who may require more support after hospital discharge and communicates these concerns.
Utilizes length of hospital stay, past utilization of resources and risk stratification to identify patients at high risk for readmission.
Interfaces effectively with the Utilization Review department to stay current on patient’s eligibility for admission, continuing stay, or readiness for discharge.
Communicates with medical staff, coordination team and nursing staff regarding appropriateness of admission, need for continued stay and discharge plans.
Identifies and records episodes of avoidable days.
Evaluates the appropriateness of care delivery in the inpatient setting and communicates any discrepancies with the medical team.
In addition to the above Care Managers in the Emergency Department will also be responsible for the following duties:
Screens ED admissions using established criteria for specific payer populations
Understands insurance/payer policy language, benefits and authorization requirements for admission
Discuss payor criteria and issues on a case-by-case basis with clinical staff
Ensures that the patient is in the appropriate “status” and level of care for the clinical condition. Utilizing screening criteria and physician advisor, per department standards
• Outpatient Care Management Specific
Receives referrals on patients being seen in the clinic (Primary Care, SDC, specialty office, ancillary departments). Coordinates services for medical and non-medical care coordination needs that are episodic or longitudinal.
Receives referrals for elective procedure patients who would benefit from pre-discharge planning assessments and resource coordination.
Assists patients through care transitions from hospital to home, SNF to home/assisted living, or alternate setting per program guidelines.
Manages a panel of high-risk patients that require longitudinal education and support.
Effectively collaborates with Inpatient Care Managers and Social Service Care Managers to address the needs of shared patients.
Able to function effectively as a part of a team. Utilizing shared knowledge to address complex patient needs.
Supports Billings Clinic and community-based programs to advance the role of Outpatient Care Management, strengthen partnerships and meet department and patient needs.
Minimum Qualifications Education
ExperienceCertifications and LicensesBillings Clinic is Montana’s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more atwww.billingsclinic.com/aboutus (https://www.billingsclinic.com/about-us/) Billings Clinic is committed to the principles of Equal Employment Opportunity. All policies and processes are designed toward achieving fair and equitable treatment of all employees and job applicants. Employees are encouraged to discuss any concerns they have in this regard with their immediate supervisor and/or the Vice President People Resources. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, creed, religion, national origin, gender, gender identity, sexual orientation, age, marital status, genetic information or disability. • Billings Clinic policy and procedures, both organizational and departmental
• Personal computers, hardware and software
• Billings Clinic Code of Business Conduct
• Billings Clinic Corporate Compliance Program
• HIPAA and confidentiality requirements
• Patient’s/resident’s rights
• Customer service techniques and Personal Service Excellence (PSE)
• Lean Six Sigma principles and concepts
• Patient safety standards
• Fiscal management
• Health care reimbursement
• Utilization review
• Discharge planning
• Nursing or social work practices
• Clinical knowledge and expertise specific to cardiac and stroke care
• Process improvement principles
• Change management principles
• Management and leadership theories and principles
• Group dynamics
• Professional communication skills, both verbal and written
• Identifying problems and researching and recommending solutions
• Establishing and maintaining effective working relationships with patients, staff and public
• Advanced communication skills, both verbal and written
• Conflict resolution
• Leadership skills to facilitate teams relating to clinical pathways and to bring about required changes
• Organizational change
• Define and implement an evolving role of patient centered care delivered in a complex integrated health care system which includes setting common goals, merging resources, providing education, and cross training of roles.
• Educate staff, patients, and public
• Communicate clearly and effectively, both verbal and written
• Incorporate cultural diversity and age appropriate care into all aspects of communication and patient care; scope of services provided will encompass age groups ranging from infant through geriatric
• Establish and maintain effective working relationships
• Incorporate population specific needs into all aspects of communication and patient care; scope of services provided will encompass age groups ranging from infant through geriatric
• Work independently
• Understand and analyze data
• Communicate clearly
• Interpret, adapt and apply guidelines and procedures
• Work with a variety of diverse and complex patients, families, and both internal and external health care providers
• Perform tasks or duties with frequent interruptions and changing priorities
• Lift, bend, stretch and reach to accomplish duties
• Adequate manual and finger dexterity required to perform appropriate procedures, write legibly, and manipulate laptop computer
• Adequate visual acuity required to read, interpret and transcribe written material and to perform appropriate procedures
• Adequate hearing and verbal communication skills to perform procedures and interact with patients, families and other health care providers
• Complexity & Difficulty
Ability to define and implement an evolving role of patient centered care delivered in a complex integrated health care system which includes setting common goals, merging resources, providing education, and cross training of roles.
• Must be able to work with a variety of diverse and complex patients, families, and both internal and external health care providers.
Bachelor of Science in Nursing (BSN) or Bachelor of Arts in Nursing (BAN) preferred
Five (5) years of professional nursing (one within the Billings Clinic) in a related cardiac care area such as critical care, ambulatory telemetry unit, or emergency services
Healthcare Provider and ACLS CPR certifications At hire
National Institutes of Health Stroke Scale (NIHSS) certification required or to be obtained within first year of employment Within 1 year of hire
Current Registered Nurse license in the state of Montana at hire