RN Case Manager

Job Code: 26063

Position Summary

The RN Case Manager functions as a resource and advocate on behalf of the patient and family while assisting in the navigation of the health care delivery continuum by operationalizing multiple processes. Coordinates hospital transitions to the next level of care, including, but not limited to, medical community partners, Kootenai Care Network, and ambulatory clinic care coordinators.

Responsibilities

• Participates in utilization management, discharge planning, patient throughput, and evaluates the appropriate use of hospital resources by ensuring that patients meet medical necessity during their hospitalization

• Utilizes the organizational approved references and software programs to assess medical necessity

• Responsible for managing payer relations and requirements to achieve optimum reimbursement and patient outcomes

• Reviews documentation for quality assurance and clinical validation

• Ensures CMS discharge standards are achieved

• Provides case management in collaboration with the medical staff, nursing, and ancillary departments throughout the hospital to ensure a safe, timely, transition to the appropriate level of care

• Familiar with standard concepts, practices, and procedures within the field

• Relies on experience and judgment to plan and accomplish goals

• Regular and predictable attendance is an essential job function

• Competent to meet age specific needs of the unit assigned

Requirements and Minimum Qualifications

• State of Idaho Registered Nurse or licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the "multistate privilege to practice" compact with Idaho

• Licensed RN with a minimum 3 years’ patient-facing RN experience at time of hire, ADN or diploma required; BSN or higher preferred.

• Licensed RN's with less than 3 years’ patient-facing RN experience as an ADN at time of hire are required to be enrolled in a baccalaureate (or higher) degree program in nursing within 1 year of employment, with BSN completion within 3 years of hire

• Minimum 3 years clinical practice experience required

• Previous utilization review experience preferred

• Current Certified Case Manager (CCM) certification, American Case Management (ACMA) certification, Certified Professional Utilization Review (CPUR) or Case Management Administration Certification (CMAC) preferred

• Excellent communication, organizational and interpersonal skills. Ability to work independently and manage time and decisions

• Proficiency with standard software applications including spreadsheets and word processing required. Experience using Interqual preferred

• Knowledge of healthcare law and regulations related to acute care and the immediate post-acute continuum preferred

Working Conditions

• Must be able to maintain a standing and/or sitting position

• Typical equipment used in an office job

• Repetitive movements

About Kootenai Health:

Kootenai Health is a highly esteemed healthcare organization serving patients throughout northern Idaho and the Inland Northwest. We have been recognized with many accolades and distinctions, including being a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet™ Status for Nursing Excellence. We pride ourselves on our outstanding reputation as an employer and a healthcare provider.

As your next employer, we are excited to offer you:

• Kootenai Health offers comprehensive medical plan options, including options for fully paid employer premiums for our full-time employees. For part-time employees, we offer the same plan options with affordable part-time premiums. In addition to medical insurance, we offer many voluntary benefits ranging from dental and vision to life and pet insurance. Kootenai Health also offers well-being resources and telemedicine service options to all employees, regardless of benefit eligibility. Benefits begin on the 1st of the month following 30 days of employment.
• Kootenai Health’s tuition assistance program is available after 90 days. If you want to further your education, we'll help you pay for it
• Kootenai Health sponsors retirement plans for employees that enable you to save money on a pre-tax and Roth after tax basis for your retirement. Kootenai Health will match your contributions based on years of service ranging from 3-6 percent.
• Competitive salaries with night, weekend, and PRN shift differentials
• An award-winning and incentive-driven wellness program. Including a MyHealth corporate team, onsite financial seminars, and coaching
• Employees receive discounts at The Wellness Bar, PEAK Fitness, and more
• Robust and interactive employee referral program
• And much more

Kootenai Health provides exceptional support for extraordinary careers. If you want to work on a high-quality, person-centered healthcare team, we can't wait to meet you!

Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex. Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.