ROLE SUMMARY

The Registered Nurse in the RN Case Manager role integrates health care for clients from pre-admission to post-discharge. The nurse functions in structured and unstructured health care settings. The nurse utilizes independent nursing judgment when integrating health care. The nurse has knowledge of and utilizes appropriate age-related patient care protocols relating to the physical and psychological needs of neonatal, pediatric, adolescent, adult and geriatric patients.

CORE RESPONSIBILITIES

1.    Coordinates development, implementation, monitoring and modifying of an individual’s plan of care through an interdisciplinary and collaborative team process.

2.     Manages individuals with focus on high risk individuals/populations across the continuum of care.

3.     Participates in resource/utilization management by maintaining expertise on benefits, reimbursement and contract/regulation changes of managed care, Medicare, Medicaid and commercial payers to allow optimization of reimbursement on a case-by-case basis.

4.     Documents InterQual criteria in clinical terms in patient’s record to validate patient meets criteria for admission, continued stay and discharge.

5.     Coordinates patient/family conferences for patients with extended length of stay or complicated needs as indicated.

6.     Identifies, analyzes and reports Case Management findings to facilitate performance improvement through accurate preparation and maintenance of reports, records and statistics.

7.     Coordinates and communicates care and continuum planning in collaboration with the patient, family, physician, members of the multidisciplinary team and payers assuring that individuals are treated at the appropriate level of care across the continuum.

SKILLS, KNOWLEDGE, AND ABILITIES

·               Ability to communicate effectively and interact positively with patient, patient’s family, staff and physicians so as to promote positive patient care.

·               Ability to function independently. Computer knowledge.

·               Ability to adapt to flexible work routine/schedule.

MINIMUM REQUIREMENTS

·               Nursing degree (BSN, Diploma, AD) from an accredited school of nursing.

·               Licensed to practice professional nursing in the state of Wyoming.

·               Minimum of 2-3 years experience in hospital nursing. Knowledge of the hospital structure, nursing policy and procedures, billing process, DRGs, and Carepaths.