RN Case Manager
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
- Hired after January 1, 2019, BSN completed within 2 years of hire
- Minimum 3 years clinical practice experience required
- Previous utilization review experience required
- Current Certified Case Manager (CCM) 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 lift and move up to 25 lbs
- Must be able to maintain a standing and/or sitting position
- Typical equipment used in a clinical job
- Must be able to stoop, crouch, or bend
About Kootenai Health
Kootenai Health has a solid reputation in the Pacific Northwest and has a rich history that spans nearly 60 years of innovation, achievements, and healthcare benchmarks. Our main campus is located in Coeur d'Alene, Idaho, and includes a 330-bed community-owned hospital. We have been recognized among large employers as the No. 1 Best Place to Work in Healthcare by Modern Healthcare magazine and are regularly recognized by Cleverly and Associates for providing value to our community.
- Four Time Magnet Designated since 2006 – This designation is nursing's top honor, accepted nationally as the gold standard in nursing excellence. Kootenai was the first hospital in the Inland Northwest to receive this designation and the second in Idaho.
- Member of the Mayo Clinic Care Network – In 2014, Kootenai Health became the 30th member, a national network of like-minded organizations that share a commitment to better serving patients and their families. Kootenai Health is the first health care organization in the Pacific Northwest to be selected as a member of the Mayo Clinic Care Network, and, like all network members, will remain a locally-owned and independent health care provider.
- Most Wired / Wireless Hospital, Hospital & Health Networks – Kootenai is consistently named one of the country's 100 Most Wired hospitals. In this same survey, Kootenai also earned a spot on the Top 25 Most Wireless hospitals.
- Three Time Great Workplace Award – Kootenai Health has been recognized as one of the most engaged and productive workforces in the world!
As your next employer, we are excited to offer you:
- 100% employer-paid health insurance premiums for full-time employees. Part-time employees pay only a small portion a month for medical, dental, and vision coverage
- Access to tuition reimbursement
- 457 investment plan through Fidelity with a match of 3-6% based on years of service and a defined contribution account which puts 2% of annual income into a retirement account
- Employee child daycare - within walking distance
- On-site learning through the Organizational Development department and teaching modules
- Robust and incentive-driven Wellness Plans
- Full-spectrum employee reward, recognition, and retention programs, including outstanding employee development, training, and educational opportunities
- And much more!
If you have questions, don't hesitate to get in touch with Jessica Van Driel at jvandriel@kh.org
We look forward to getting to know you better!
Kootenai Health complies with applicable federal civil rights laws and does not discriminate based on 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.
Location: Kootenai Health · Transitional Care Services - Care Management
Schedule: Full Time, Days