Company:

Providence at Home with Compassus

 

Position Summary

The Care Management RN conducts audits and evaluation of patient records and will use professional clinical skills to evaluate opportunities to optimize clinical resource management, utilization of services, and length of stay to ensure our patients receive quality, cost effective care and to maximize patient outcomes in alignment with agency and industry standards and financial metrics.
The management of resources and the coordination of the continuum of care will be performed in a manner consistent with the mission, vision, and core values of Providence St. Joseph Health.

Position Specific Responsibilities

• Assessment: The Care Management RN will assess the patient’s clinical condition and appropriateness of the requested services based on the documentation in the medical record and the organization’s approved utilization review guidelines.

• Planning: Collaborates with Director, Clinical Managers and other members of the interdisciplinary healthcare team to ensure documentation supports medical necessity and appropriateness of planned treatments and services.

• Implementation: Will compete reviews timely, document in the appropriate electronic medical record, and maintain files according to department standards and policy and procedures using principles of appropriate utilization review and evidence of coverage guidelines.

• In conjunction with Director and Clinical Managers participates in ongoing staff education regarding utilization guidelines, documentation of medical necessity, clinical appropriateness of services provided.

• Coordination: Interacts with other members of the interdisciplinary team and other Departments and Programs as needed.

• Escalates cases for review to Clinical Manager and Director as appropriate.

• Monitoring: Will develop and participate in appropriate studies, audits and/or surveys to provide appropriate and measurable outcomes to Quality Management Team.

• Communication: Fosters cordial, positive and professional interpersonal relationships with members of the healthcare team, community agencies and peers.

• Develops high level negotiating skill to effectively work with all members of the healthcare team in order to maximize utilization, quality, and service.

• Identifies other issues that may affect patient care, impact utilization of services or lead to increased length of stay (insufficient medical record documentation, lack of timely test or treatment, etc.), and communicates findings to the appropriate Clinical Manager and Director.

 

Education and/or Experience

Required - Coursework/Training Graduate of an accredited school of nursing.Preferred - Bachelor's Degree Nursing.Required - 1 year Experience as a RN in a Home Health and/or Hospice setting.Preferred - Utilization review/quality management performance improvement experience.

Skills

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage.Language Skills: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders, team members, investors, and external parties. Strong written and verbal communications.Language Skills: Ability to understand, read, write, and speak English. Articulates and embraces integrated healthcare at home philosophy.Computer Skills: Intermediate computer skills including knowledge of basic computer software programs.Computer Skills: Basic computer skills including Windows, Microsoft Word, Microsoft Excel, internet navigation and an email system.Other Skills and Abilities: Demonstrates effective interpersonal and communication skills.Other Skills and Abilities: Demonstrates tact, diplomacy, negotiation skills, and customer relations.Other Skills and Abilities: Ability to apply creative problem solving skills.Other Skills and Abilities: Ability to prioritize assignments and effective time-management skills.Other Skills and Abilities: Knowledge of diagnosis, expected treatment and discharge planning needs.Other Skills and Abilities: Knowledge of clinical and psychosocial aspects of patient care.Other Skills and Abilities: Ability to present a professional presence and appearance.Other Skills and Abilities: Detail-oriented, flexible, and committed to patient advocacy.Other Skills and Abilities: Ability to work interdependently.Other Skills and Abilities: Demonstrated skills in planning, organizing and managing multiple functions and complex processes.

Certifications, Licenses, and Registrations

Required upon hire: Active Registered Nurse (RN) license in the state of employment (may be vendor managed)CA: Required upon hire: California Registered Nurse License (Vendor Managed)

Physical Demands and Work Environment: The demands of this role necessitate a team member to effectively perform essential functions. Adaptations can be made to accommodate team members with disabilities. Regular standing, walking, and manual dexterity are fundamental, along with the ability to lift and move objects up to 50 pounds. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. In a healthcare setting, exposure to bodily fluids, infectious diseases, and conditions typical to the field is expected. Routine use of standard medical equipment and tools associated with clinical care is essential. This description provides a general overview and may vary by role and department, capturing the nuanced demands and conditions inherent to clinical positions in our organization.

At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Compensation range: $60.47 - $93.88 

  

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities 

  

Compassus offers a comprehensive benefits package including, Medical, Dental, Vision, 401k and much more. 

 

 

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