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Care Manager (RN) - Emergency Department (3pm - 11pm) ( M-F) - 68480

Company: University of Texas Medical Branch
Location: Galveston
Posted on: May 6, 2020

Job Description:

Min Qualifications
RN with Bachelor's degree in Nursing and two years of inpatient experience in a hospital environment.-- Current license or valid permit to practice professional nursing in Texas.JOB DESCRIPTION:To support the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management, care coordination and discharge planning functions.Salary Range
The salary range for this position is from $64,615 to $103,384 annually, commensurate with experience.--Specific Job Related Duties
--- Utilization Managemento Ensure clear admit status and timely management of observation patientso Demonstrates knowledge of CMS guidelines and use of Local Coverage Determination (LCD) or inpatient and observation, CMS inpatient only list, and other payor guidelines as requiredo Demonstrates thorough knowledge in the application of InterQual criteria; Severity of illness (SI), Intensity of service (IS), Discharge screens (DS) SI, IS, and performs continued stay reviews for Medicare, Medicaid and self pay patientso Demonstrates skill in accurately entering required UM data. Works closely with denials/appeals coordinatoro Elevate to department leadership all patients not meeting medical necessity criteria after impasse with attending physiciano Creates final patient discharge disposition (closing of cases)--- Level of Careo Ensure appropriate level of care/patient statuso Facilitate clinical care progression of patient by multidisciplinary team throughout stayo Demonstrates knowledge of CMS guidelines and use of LCD for inpatient and observation, CMS inpatient only list, and other payor guidelines as requiredo Demonstrates appropriate application of InterQual LOC criteria to evaluate current patient care needs.o Elevate to department leadership all patients in an inappropriate level of care after impasse with attending physician;documents avoidable days--- Assessment of patients' financial, emotional, physical, social, functional and health care needso Demonstrates ability to assess discharge needs of all patients, and ability to prioritize patients by need, e.g. Medicare, high risk diagnoses, high risk for readmission, identified vulnerable patientso Identify readmission risk and target interventions to reduce risk for readmissiono Define and recommend potential discharge plano Utilize assessment to begin management of patient and family expectations regarding the plan of care--- Care Coordination of Treatment Plan: Medical and Multidisciplinaryo Participate in multidisciplinary rounds. Facilitates clinical care progression of multidisciplinary team in a timely and efficient mannero Facilitate Patient Care conferences based on patient/family needso Manage patient and family expectations the plan of careo Contact appropriate ancillary department with any delays impacting care progressiono Address incomplete, unclear medical plan of care with attending physician. If unsuccessful, elevate to department leadership, director or physician advisor as appropriate.--- Length of Stayo Use basic knowledge of target LOS for patient diagnosis, actively monitor LOS timeframe and implement measures to achieve targetso Ensure timely intervention to prevent delays in service and transition of careo Document Avoidable Dayso Identify, adjust and manage barriers to dischargeo Elevate to manager all patients with an inappropriate length of stay after impasse with attending physiciano Present Long LOS case----- Discharge Planningo Demonstrate skill in educating patient/family and physicians regarding post acute options and addresses issues of choiceo Demonstrate skill in developing clinically comprehensive discharge plans with patient, family, and applicable health care providerso Manage family expectationso Adjust and manage barriers to dischargeo Collaborate with Social Worker dailyo Arrange or facilitate identified discharge needs and services of patients--- Communicationo Demonstrates competency and skill in communication with patients, families, hospital staff, and visitorso Demonstrates skill in communicating with physicians the necessary documentation to demonstrate medical necessityo Demonstrates collaboration, professionalism and ability to work with all health care providerso Demonstrates ability to work with people of all social, economic and cultural backgrounds and is flexible, open minded and adaptable to changeo Demonstrates capacity to manage "crisis situations"o Demonstrates skill and success in collaboration with Social Worker partner--- Documentationo Demonstrates competency in timely and complete clinical, social, and functional patient assessmento Demonstrates timely and thorough documentation of proposed discharge plan A & Bo Provides subsequent interactions with patient/family and appropriate physician discussionso Creates patient discharge disposition and collaborates with Social Worker to ensure documentation of final outcome in chart--- Time Managemento Demonstrates proactive, accurate, and timely assessmento Demonstrates timely response to request for case management interventiono Demonstrates skill in prioritizing case load for appropriate level of case management interventiono Demonstrates ability to coordinate and manage continuum of careo Demonstrates strong problem solving skillso Demonstrates timely documentation and closing of cases--- Performance Improvemento Demonstrates support of the Care Management department and active participation in improving performance and achieving departmental goalso Demonstrates active participation in system, institutional and unit specific initiativeso Demonstrates understanding of the hospital's mission, vision, values, culture and policieso Adheres to internal controls and reporting structureWork Schedule
3p to 11p Monday - FridayEqual Employment Opportunity
UTMB Health strives to provide equal opportunity employment without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or veteran status. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.
Req id: 68480

Keywords: University of Texas Medical Branch, Galveston , Care Manager (RN) - Emergency Department (3pm - 11pm) ( M-F) - 68480, Healthcare , Galveston, Texas

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