RN Case Manager - Days

RN Case Manager

INTEGRIS Health Baptist Medical Center, Oklahoma's largest not-for-profit health system, has a great opportunity for a RN Case Manager in Oklahoma City, OK. In this position, you'll work 8:00 am - 4:30 pm Full-time with our Case Management team providing exceptional care to those who have entrusted INTEGRIS Health with their healthcare needs. If our mission of partnering with people to live healthier lives speaks to you, apply today, and learn more about our increased compensation plans and 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.

Job Description

• Responsible for the clinical and financial outcomes for an assigned caseload of patients as appropriate.
• Facilitate patient care during hospitalization by managing, coordinating, and monitoring resource utilization to achieve optimal clinical outcomes and financial goals.
• Proactively plan, coordinate, and negotiate efficient patient movement throughout the continuum of care.
• Function in the role of clinician, educator, researcher, manager, and advocate to serve the best interests of the system and patient.
• Complete a comprehensive assessment of patients' clinical, psychological, and financial needs utilizing all available resources.
• Recommend and coordinate timely transfers to appropriate levels of care as indicated by clinical needs and utilization criteria.
• Develop, implement, evaluate, and revise a plan for discharge, including referrals to other health care and community organizations based on needs assessment.
• Communicate discharge care plan and any changes in the plan to patient, family, and all appropriate healthcare professionals.
• Assist physicians and hospital staff in appropriate utilization of resources through application of utilization criteria and facilitating timely discharge planning for patients.
• Coordinate services between hospital departments to facilitate timely patient discharge.
• Conduct concurrent review of patient records on admission to the hospital and as determined by the patient's clinical condition.
• Apply utilization criteria accurately in order to determine appropriate utilization of resources.
• Notify designated internal and external contacts of utilization issues that may affect patient care and/or reimbursement.
• Facilitate patient transfers to other health care organizations in accordance with hospital policies and all applicable state and federal guidelines and regulations.
• Act as a resource/advisor to physicians regarding discharge planning, medical record documentation, and all issues that may affect resource utilization and reimbursement.
• Integrate and manage established pathways, where available, to enhance clinical effectiveness and clinical resource management.
• Maintain knowledge and understanding of CMS regulations, Medicare/Medicaid, managed care, and other payer regulations and benefit limits.
• Act as a resource and provide education for patients, their family members, and all health care professionals regarding HCFA regulations, Medicare, Medicaid, managed care, and other payers.
• Develop and maintain knowledge and understanding of hospital and community resources, facilitating use of the most appropriate level of care to conserve patient, hospital, and payer resources.
• Identify opportunities to reduce the cost of managing patient care without impacting quality or outcomes.
• Participate in collecting and recording data for utilization and Quality Improvement reporting.
• Work collaboratively and professionally with patients, family members, physicians, hospital staff, and other individuals and agencies involved in providing patient care.

Mental Health Responsibilities

• Lead age and developmentally appropriate patient education and recreational groups to address the emotional, physical, and environmental needs of Mental Health and/or Chemically Dependent patients.
• Provide documentation daily in patients' charts on each group facilitated.
• Facilitate discharge planning to assist patients in placement and treatment following discharge.
• Participate in the development of patient plans of care to address goals of the patient (emotional, physical, spiritual, environmental) by attending treatment team meetings.
• Participate in the writing of treatment plans with other program staff and physicians on hospital-approved forms.
• Assist in the utilization review process by contacting patients' insurance companies to provide clinical information to authorize patient treatment.
• Serve as a patient advocate in the patients' needs as well as those individuals involved with patients (as relevant).
• Assist in the development and execution of marketing the program services to appropriate entities (outpatient therapists, primary care physicians, inpatient programs, etc.).
• Complete or facilitate the completion of Emergency Detention paperwork, ensuring its distribution and receipt by legally designated individuals.
• Provide physician-ordered therapy in the areas of individual, family, and marital sessions.
• Develop and facilitate age and developmentally appropriate patient psychotherapeutic groups.
• Review and note physician orders.
• Monitor patients' medications and provide education related to use and side effects.
• Monitor vital signs as indicated by physician orders or if deemed medically necessary.
• Assess patients for appropriateness of admission to the program.

INTEGRIS Certified Case Management Responsibilities

• Document and communicate in a timely fashion patients' progression throughout the continuum of care to all necessary parties via electronic, written, and verbal means.
• Apprise team members of challenges encountered throughout the continuum of care via electronic, written, and verbal means.
• Utilize strong organizational skills to personally manage an evolving calendar of commitments in the best interest of the patient and organization.
• Utilize excellent interpersonal, collaborative, and conflict resolution skills to act as a liaison between the patient, medical provider, and the organization to achieve positive outcomes.

For INTEGRIS Decisions Only

• Lead age and developmentally appropriate patient education groups to address the emotional, physical, and environmental needs of Behavioral Health and/or Addiction Recovery patients.
• Participate in the writing of treatment plans with other program staff and physicians.
• Assist in the utilization review process by contacting patients' insurance companies to provide clinical information to authorize patient treatment.
• Serve as a patient advocate in the patients' needs as well as those individuals involved with patients.
• Complete or facilitate the completion of Emergency detention paperwork ensuring its distribution and receipt by legally designated individuals.
• Process orders/refills or laboratory for ordering physician.
• Monitor patients' medications and provide education related to use and side effects.
• Monitor vital signs as indicated by physician orders or if deemed medically necessary.
• Provide referral options for patients who are assessed but do not enter the program.
• Complete a comprehensive Initial Mental Health Assessment of patients' clinical, psychological, and financial needs utilizing all available resources.
• Attend and participate in treatment team meetings.

The Case Manager reports to the Director of Case Management Services. The Case Manager meets established deadlines, attends required in-services, maintains staff competencies, completes required documentation; collaborates and works as a team player with all disciplines; presents a professional image to all customers and patients.

Mental Health Case Managers report to the Unit Program Manager. INTEGRIS Certified Case Managers report to the Process Manager, Disability Management. Jim Thorpe Rehab Hospital staff report to Mgr Post-Acute Care and Rehab. Mental Health staff must be able to assist with physical restraint of patients utilizing the Mandt System.

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.

Required to be on call as scheduled by the department.

Potential exposure to infectious diseases, potential physical danger from disturbed/irate patients and families. Emotional stress due to inability to control volume or 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.