RN-IMM CASE MANAGER-Presbyterian Hospital - Full time - Days
Location: Albuquerque New Mexico
Description: Presbyterian Healthcare Services is currently seeking to employ RN-IMM CASE MANAGER-Presbyterian Hospital - Full time - Days right now, this job will be placed in New Mexico. For detail informations about this job opportunity kindly see the descriptions. Minimum Skills/Requirements
Skills: Bachelors degree in Nursing, Business, or Health! related field preferred. RN license required. Five years experience in clinical nursing. A minimum of two years of recent experience in acute clinical, utilization review, or case management within the last 10 years. National certification preferred within 3 years of hire. Computer knowledge to include Windows, Word, Excel, and database systems. Ability to analyze trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation, & cost containment. Knowledge of regulatory requirements inclusive of NCQA, CMS, JCAHO, DOI, HSD. Knowledge in referral coordination to community & private/public resources. Knowledge: Requires detailed knowledge of utilization management principles and cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level includes interpretation of data. Abilities: Mental Power: Ability to make decisions that require ! significant analysis and investigation with solutions requirin! g significant original thinking. Mental Power: Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies, procedures or protocols. Decisions include such matters as critical thinking, order in which work is done, and application of established procedures. Physical Power: Walks, sits, stands in place, arm/wrist/hand movement, lifts. Driving; sitting at computer; using laptop.
Primary Job Functions
- Identifies and advocates for patients and members in caseload, referring to appropriate inpatient, outpatient and community resources including care coordination.
- Conducts an in-depth assessment which includes, psychosocial, physical, medical, environmental and financial parameters. Collaborates with Healthcare team to proactively develop, implement and document treatment and discharge plan with appropriate resources to address social, physical, mental, emotional, sp! iritual and supportive needs.
- Collaboratively formulates, implements, coordinates, monitors, and evaluates strategies with the healthcare team to address care management issues for specific patients and disease processes.
- Applies utilization review criteria to assess and document the appropriateness of admission, continued stay, level of care, and readiness for discharge; refers cases that do not meet criteria to designated Physician Advisor. Promotes the appropriate use of clinical and financial resources in order to improve quality of care and patient/member satisfaction.
- Performs cost-benefit analyses and negotiates rates with providers and vendors. Interfaces and negotiates with insurance companies and other payers to ensure payment for services. Generates reports, which demonstrate efficacy through direct cost-savings and outcome measures.
- Actively participates in the development of clinical guidelines and pathways and incorporates p! rocesses into the role of nurse care coordinators.
- Educates pr! oviders and other PHS/PHP departments on health management strategies and care coordination services.
- Ensure that quality of patient and member cares is maintained or surpassed by collecting and analyzing quality indicators.
- Facilitates and leads patient and member care conferences.
- Performs other functions as required.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Presbyterian Healthcare Services.
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This job starts available on: Mon, 15 Oct 2012 21:50:30 GMT
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