Case Manager/Utilization Review (RN)

Case Manager/Utilization Review (RN)

02 Sep 2020
Wyoming, Kemmerer 00000 Kemmerer USA

Case Manager/Utilization Review (RN)

Case Manager/Utilization Review (RN)

The RN with the Acute Care department provides quality nursing care to assigned patients to ensure that the patient's physical and psycho-social needs are met. The RN also ensures that the patients care is documented and that their families are well informed of the patient's status.

Desired Education, Certifications and/or Experience

  • Wyoming RN license

  • One to three-year experience in Discharge Planning, Utilization Review and Case Management preferred.

Responsibilities / Functional Job Description

General: Standards of Behavior

1. Demonstrates a commitment to living the SLHD standards of behavior though exemplifying in action, a commitment to the values of SLHD, namely:

a. Innovation- continually seeking the latest advances in cost effective healthcare and customer service.

b. Compassion- concern for the individual, empathy for the situation, action to provide service

c. Integrity- doing the right thing: always

d. Community-supporting, giving and acting to improve where we live, serve, and work.

e. Passion for Healthcare-fervently, avidly and zealously seeking the improvement of human health

2. Displays this commitment to the standards of behavior through actions and words, by demonstrating the following behavior traits:

a. Adaptability - Responding resourcefully to changes in direction, priorities, schedules, approaches and responsibilities for the good of everyone. Maintaining a positive attitude when faced with a difficult or challenging situation and providing an uplifting and realistic outlook on the opportunities the future may present.

b. Communication - Listening attentively and seeking clarification, being friendly in words and actions, responding to others in a timely manner to ensure satisfaction, comfort and quality care. Utilizing AIDET and the promise to explain the experience the patient can expect, and communicate how the patient will receive excellent and timely care.

c. Professional Conduct and Attitude - Keeping personal conversations to an appropriate volume for the area I am working in, treating everyone in a courteous manner - rudeness is never acceptable, addressing conflict with others privately and respectfully and utilizing the appropriate chain of command. Doing the right thing, even when no one is watching, keeping frustration separate from patient care and professional activities, and recognize that patients are not an interruption, they are our reason for being here.

d. Commitment to Team Members/Patients - Assist patients in finding their destinations, walking with them when possible, interacting constructively with team members and supporting a blame free environment, recognizing there is no place for "it's not my job", finding the right person to support a patient or coworker if I am unable to support or help them. I will not spread negativity, being positive starts with me.

e. Personal and Career Development - Demonstrating a curiosity toward learning and practicing self-development. Supporting co-workers by sharing knowledge, expertise and encouragement to help them be successful in their role. Finding ways to improve the quality of my work even when things are going well. Seeking creative solutions to problems and encouraging creativity in others.

f. Sense of Ownership - Admitting and correcting mistakes, taking personal responsibility to help the organization to succeed. Ensuring cleanliness by maintaining a clutter free environment. Refraining from behavior or conversations that undermine the confidence of the community in our facility. Utilizing resources effectively and maintaining financial responsibility.

General: Performance Expectations

1. Responsible - works independently, in a safe and appropriate manner. Demonstrates both problem-solving and problem-prevention skills.

2. Sensitive - displays sensitivity to the needs of patients and co-workers. Demonstrates good communications skills and empathy.

3. Timely - recognizes time as a customer's most valuable resource and responds promptly to patients' and co-workers' needs.

4. Accurate - works carefully and precisely, with attention to detail.

5. Coordinated - organizes and delivers service in the proper order. Displays good organization skills and utilizes resources wisely.

6. Thorough - meets all the requirements of his/her position. Is able to evaluate and follow up on his/her services.

General: Teamwork and Service Expectations

7. Display and encourage sensitivity to needs of patients, visitors, and co-workers.

8. Treat others with consideration, courtesy and respect.

9. Perform duties willingly and with initiative; shares necessary information so co-workers can do the same.

10. Remain composed and takes actions to restore calm in stressful situations.

11. Demonstrate judgment and tact when dealing with others.

12. Cooperate with other hospital departments and work groups.

13. Communicate effectively with patients, visitors, and co-workers; take action to clarify information received from others.

Role Specific: Work role responsibilities

1. Provides direction to para and non-professional personnel to perform their duties in accordance with their level of expertise.

2. Has major responsibility for assessing, planning, implementing, and evaluating quality patient care which is consistent with the established hospital and nursing service policies and procedures.

3. Is responsible for teaching patients and others.

4. Responsible for initiating, developing, and coordinating a discharge plan with assigned patients in collaboration with the physician and other health care providers.

5. Responsible for maintaining the dignity and confidentiality of the patient and serves as a patient advocate at all times.

6. Is responsible for maintaining an up-to-date knowledge of nursing trends and new developments in the healthcare field in order to promote optimal standards of nursing care.

7. Utilizes effective human relation and communication skills in interfacing with hospital personnel, patients, and others.

8. Is responsible for making independent nursing decisions relating to patient care.

9. Interviews and counsels patients, families or significant others for options as related to discharge planning as indicated. Acts as a patient advocate.

10. Evaluates for and initiates referrals to appropriate agencies and interdepartmental services.

11. Includes patient, family, significant others in assisting to establish the discharge plan of care.

12. Is knowledgeable of resource information available and provides information to patients, families, staff, providers, and community. Facilitates communication among all disciplines involved in the provision of care.

13. Maintains current knowledge of Federal and State regulatory guidelines.

14. Reviews patient data a minimum of once daily and as needed.

15. Assist with updating discharge planning/case management/ utilization review policies and procedures annually and as needed.

16. Completes screening tools as indicated to improve quality of care.

17. Maintains current resources and knowledge of durable medical equipment services, rehabilitative options, home care services and long term care facilities.

18. Participates in community events as appropriate.

19. Actively participates in self development by attending educational programs offered inside and outside the facility.

20. Contacts insurance companies for nursing follow up.

21. Provides or arranges for financial counseling as indicated (i.e., HINN letters, BIPA notices, ABN/s payment plans).

22. Ensures continuity of care by communicating appropriate patient information to any health care organization or provider to which the patient is admitted, transferred or discharge.

23. Uses current utilization guidelines/criteria

24. Evaluates the severity of illness and intensity of service, discharge readiness, outlier and co-morbidity issues.

25. Educates providers and other staff regarding necessary documentation to evidence medical necessity and continuing care plan.

26. Assists with tracking, trending, and displaying utilization data and making recommendations for improvement.

27. Performs other duties as assigned

28. Provides for quality of nursing service by maintaining a safe patient environment through professional conduct and practices, compliance with policies and procedures, and participation in an ongoing review of QA processes and monitors.

a. Administers medications/IVs in a safe manner

b. Develops and supports a safe patient environment

c. Maintains training in the use of equipment for patient care

d. Reviews and properly processes orders

e. Performs appropriately in crisis situations

f. Participates in QA program

29. Accountable for cost-effective patient care through monitoring the use of personnel, time supplies, and equipment

a. Attends work in a punctual and dependable manner

b. Manages time and uses supplies based on patient needs and medical/nursing plans of care.

c. Assures that charges are accounted for and are recorded to the patient billing system.

30. Accountable for coordinating patient care activities with patient, colleagues, other hospital personnel, and physicians.

31. Accountable for maintaining patient confidentiality.

a. Communicates effectively with patients and others

b. Understands patient rights and complies with confidentiality policies

c. Functions competently under stress

d. Communicates and solves problems with coworkers, physicians, and other hospital employees.

e. Demonstrates appropriate problem-solving ability and support of hospital philosophy and policies.

32. Performs other duties as assigned

Desired Knowledge, Skills & Abilities

1. Knowledge of state and federal regulations, policies, and procedures governing accounting, medical billing and financial recordkeeping.

2. Knowledge of general accounting principles and ability to produce, read and analyze financial reports

3. Knowledge of accounting and finance best practices and programs which enhance the financial success of the organization

4. Knowledge of financial/revenue cycle reporting and key performance indicators for measuring and benchmarking performance

5. Ability to operation various office equipment

6. Skill in accuracy and attention to detail

7. Ability to perform public relations and public speaking in a professional manner

8. Ability to maintain confidentiality

9. Ability to read, write legibly and calculate mathematical figures

10. Ability to solve practical problems and deal with a variety of variables

11. Ability to work with, lead and supervise others

12. Ability to manage multiple assignments/projects; meet timelines and prioritize responsibility

13. Ability to handle stressful situations and react appropriately

14. Ability to maintain a driver's license and ability to travel distances for multiple days as necessary

15. Ability to exercise good judgement in appraising situations and making decisions

16. Ability to work and interact effectively and positively with other staff members to build and enhance teamwork across SLMC departments

17. Ability to communicate to complete responsibilities effectively

18. Ability to see to use computer efficiently and read computer reports and correspondence

19. High proficiency with Microsoft office products (excel, word, PowerPoint, etc.)

20. Knowledge of reimbursement and coding.

Equal Employment Opportunity

South Lincoln Medical Center will provide equal opportunity employment to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, gender, age, national origin, ancestry, religion, physical or intellectual disability, marital status, parental status, sexual orientation or any other category protected by law.

Americans with Disabilities Act (ADA) Statement

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand; walk; stoop, kneel, or crouch. The employee must regularly lift and/or move up to 20 pounds.

Contact Information

Megan Neal - HR Manager

Human Resources

711 Onyx Street

Kemmerer, WY 83101


Phone: 307-877-4401

Job Details

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