Schedule: Day shift- primarily weekends
Provides clinical care coordination of assigned patients, monitors patient progress, coordinates with physician to ensure patients are treated at appropriate level of care, provides clinical reviews to insurance, and provides transitional planning for post acute care. Serves as a resource to physicians and nursing staff.
Key Responsibilities/Essential Functions:
- Primary functions of this nursing role in Case Management Department are: 1) clinical care coordination, 2) utilization management, and 3) transitional planning.
- Use facility adopted utilization screening criteria to assess medical necessity with governmental and third party payers.
- Collaborating with physician and communicating effectively care recommendations.
- Ensuring patients receive appropriate care according to clinical needs.
- Coordinating with physician to assure intensity of service and severity of illness supports level of care,
- Communicate with physicians regarding plan of care when patient is no longer meeting acute criteria.
- Providing clinical reviews to third party payers to secure reimbursement.
- Delivers the ideal patient experience through a customer centric approach.
- Collaborates closely with Social Work Case Manager team member.
- Participates and maintains a culture of excellence characterized by positive relationship with peers, nursing, and physicians, along with a willingness of all to strive for their best.
- May perform other duties as assigned or requested
Education and/or Experience
- Bachelor of Science in Nursing (BSN). Five years nursing experience in a clinical setting. Home health or community nursing experience desired.
MRHC Only - Current RN license in State of Kansas. BS in nursing or related health field is recommended. Certification in Case Management is preferred. Demonstrated ability to analyze patient assessment data in relation to continuum of care needs.
- A personal presence which is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Via Christi Health.
- Be able to effectively analyze situations and make good decisions in the absence of management.
- In addition to education, experience, and registration: excellent communication and teamwork skills, flexible to work in dynamic healthcare environment.
Certificates, Licenses, Registrations
- Registered Nurse (RN) in state of Kansas
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Frequently required to carry or lift items weighing up to 10 pounds.
- Occasionally required to carry or lift items weighing up to 25 pounds for short distances.
- Frequently required to stand or walk on hard and soft surfaces.
- Occasionally required to sit in a stationary position.
- Frequently performs activities that require stooping, bending and reaching, squatting, balancing, and trunk twisting throughout the day.
- Constantly able to communicate verbally and in written form.
- Frequently able to detect and discern both loud and soft sounds such as phone calls and customer questions.
- Constantly able to use hands and fingers to type, write, and file.
- Frequently able to use near vision for viewing computer monitor and written materials.
- Occasionally required to detect unusual odors that could indicate environmental issues.
- Fast paced environment throughout medical center.
Position Scope/Patient Population:
Via Christi Health is an Equal Opportunity/ Affirmative Action Employer.
- Patient age range is newborn to elderly, of all socioeconomic levels and from a wide variety of cultural/ethnic backgrounds.
- Patients have a wide range of medical conditions in this regional tertiary care medical center.
Via Christi Health System
- 3 years ago - save job