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Billings Clinic Full-time CAH RN Care Manager (Columbus) in columbus, Montana

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.

Essential Job Functions

Assessment

• Assesses patient medical records for goals of treatment plan, identifies actual and potential discharge needs at the time of admission for assigned patients. Demonstrates the ability to interpret clinical information and understand health care treatment and systems.
• Reviews services to ensure medical necessity and delivery in the appropriate setting. Monitors patient status and appropriateness of care based on medical acuity using assigned medical criteria.
• Meets with patient and family as appropriate to develop plan of care taking into consideration choice, support network(s), and appropriate level of care.
• Demonstrates sensitivity and awareness about population specific needs or special issues related to culture, race, gender, age, religion, sexual orientation, etc.

Planning: Formation of Discharge/Transitional Plans

• Assists in the coordination and implementation of discharge planning activities within expected length of stay in collaboration with interdisciplinary team. Accountable for appropriate cost-effective, realistic, and time specific discharge outcomes. Takes a lead role on RN/SW care management team with medically complex patients.
Implementation: Patient Care Coordination
• Understands insurance/payer policy language, benefits and authorization requirements upon admission, during hospital stay, and discharge including concurrent reviews while patient is being treated.
• Coordinates with referral agencies as indicated to ensure services are in place before discharge.
• Demonstrates the ability to negotiate rates/services as well as promote patient advocacy with funding and referral agencies.

Evaluation

• Reviews and monitors clinical pathways/coordinated care guides against actual treatment plan, considering individual treatment needs. Communicates with physician(s) on variances in treatment plan.
• Collects data as required and communicates variances in care (when expected outcomes are not achieved within established time frames) to supervisor and/or department Medical Director for guidance and process improvement opportunities.
• Monitors need for revisions in the care plan. Makes a recommendation to physician(s) and interdisciplinary team when indicated.

Interdisciplinary Team Participation

• Facilitates interdisciplinary team process to determine patient's functional status prior to admission and needs upon discharge. • Promotes collaboration and communication among team members.
• Serves as the resource to staff on patient's treatment and discharge plan.

Documentation

• Ensures medical records documentation supports status and need for continued stay.
• Documents care management interventions in medical record including patient/family communication, discharge plan, and disposition status. Documentation reflects professional practice.
• Performs other duties as assigned to include occasional coverage for nursing shifts in the clinic and Saturday clinic days.
• 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.
• Performs all other duties as assigned or as needed to meet the needs of the department/organization.

Minimum Qualifications
Education

• 4 Year / Bachelors Degree preferred

Experience

• Three (3) clinical experience in the assigned service or specialty area.
• One (1) year of facility experience, preferred

Certifications and Licenses

• Healthcare Provider CPR Certification - At hire
• Current Montana state license as a registered nurse required - At hire

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