INTEGRIS Health Decisions, Oklahoma’s largest not-for-profit health system, has a great opportunity for a RN Care Manager in Oklahoma City, OK. In this position, you’ll be a part of our Decisions team providing exceptional work supporting the INTEGRIS Health caregivers and the community at large. If our mission of partnering with people to live healthier lives speaks to you, apply today and learn more about our recently enhanced benefits package for all eligible caregivers such as front loaded PTO, 100% INTEGRIS Health paid short term disability, increased retirement match, and paid family leave. We invite you to join us as we strive to be The Most Trusted Partner for Health.
The RN Case Manager NE is responsible for the clinical and financial outcomes for an assigned caseload of patients. The Case Manager facilitates patient care during hospitalization by managing, coordinating, and monitoring resource utilization to achieve optimal clinical outcomes and financial goals. The Case Manager is responsible for proactively planning, coordinating, and negotiating efficient patient movement throughout the continuum of care. In general, the Case Manager functions in the role of clinician, educator, researcher, manager, and advocate to serve the best interests of the system and patient. This position requires age-related competencies and performs all other job duties as assigned. Required to be on call as scheduled by the department. Adheres to National Patient Safety Goals as appropriate based on the level of patient contact this position requires.
Responsibilities:
- Assesses patients from clinical, social, and financial perspectives and coordinates post-discharge needs with the care team.
- Functions as a clinical and financial resource for patients and interdisciplinary team members.
- Assists in clinical data collection utilizing established criteria and the InterQual system.
- Proactively performs utilization review; communicates coverage information with third party payers, medical staff, and clinical providers.
- Leads age and developmentally appropriate patient education groups to address the emotional, physical, and environmental needs of Behavioral Health and/or Addiction Recovery patients.
- Participates in the writing of treatment plans with other program staff and physicians.
- Assists in the utilization review process by contacting patients' insurance companies to provide clinical information to authorize patient treatment.
- Serves as a patient advocate in the patients' needs, as well as those individuals involved with the patient.
- Completes or facilitates the completion of Emergency detention paperwork and ensures its distribution and receipt by legally designated individuals.
- Processes orders/refills or laboratory for ordering physician.
- Monitors patients' medications and provides education related to use and side effects.
- Monitors vital signs as indicated by physician orders or if deemed medically necessary.
- Provides referral options for patients who are assessed but do not enter the program.
- Completes a comprehensive Initial Mental Health Assessment of patients' clinical, psychological, and financial needs utilizing all available resources.
- Attends and participates in treatment team.
The Case Manager reports to the Director of the Case Management Services and meets established deadlines, attends required in-services, maintains staff competencies, and completes required documentation. The Case Manager collaborates and works as a team player with all disciplines and presents a professional image to all customers and patients. Potential exposure to infectious diseases and emotional stress due to the inability to control the volume of timing of referrals and necessity to respond to a wide variety of demands and expectations from patients, families, physicians, and other health care professionals. Occupational exposure to bloodborne pathogens and other infectious materials as defined by OSHA. This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information.
All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.
Qualifications:
- 5 years of experience in a variety of clinical settings (i.e., home health, inpatient, physician office, clinic) required.
- Experience with managed care and payer/provider requirements preferred.
- Current licensure as a Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state. BSN preferred.
- Excellent interpersonal communication and collaboration skills.
- Computer experience required. Windows preferred.
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