Providence Mt. Angel Jobs

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Providence RN Case Manager Home Health in Mount Angel, Oregon

Description:

Providence is calling a RN Case Manager Home Health - Home Health Services (1.0 FTE, Days) to Benedictine Home Health in Mount Angel, OR

We are seeking a Registered Nurse (RN) Case Manager Home Health - Home Health Services that will assume accountability for the management, coordination, and facilitation of activities for a defined patient population, necessary to achieve length of stay and resource consumption outcome goals, while maintaining or improving quality of service. Functions in a leadership role as a member of a multidisciplinary team to achieve collaborative practice, coordinated care, continuity of care, consistent and/or expected clinical outcomes, efficient management, and quality improvement. Responsible for implementing the utilization review program following the HFH Utilization Management Plan and assist with quality improvement data collection. Provides leadership to staff, management, physicians and others in implementation of and compliance with Medicare/Medicaid regulations/rules/guidelines and utilization rules of third party payer contracts. Provides teaching, consultation, guidance, and advice for physician intent for admission, improved clinical documentation, and proper coding of documentation. Contributes to clinical performance improvement on units by providing direction on ways to improve efficiencies, reduce costs, receive appropriate reimbursement, meet requirements. Actively participates in CMC governance, peer review, education and support processes. Reports to Director of Case Management.

In this position you will have the following responsibilities:

  • Accept and support the mission and values of Benedictine Home Health

  • Support the Performance Improvement process

  • Follow policies related to work attendance and dress code

  • Maintain a safe environment for staff, patients, and visitors

  • Consider individual needs in communication with and assessment and treatment of patients and staff, including ethical, cultural, psychosocial, religious, and age-specific aspects, to include all ages

  • Support patient rights and the organization’s code of ethical behavior

  • Follow the principles and requirements outlined in the Commitments & Compliance Integrity Program Employee Handbook and any other organizational or departmental materials related to compliance with laws and regulatory requirements

  • As a Preceptor, provide initial job training and information to the orientees and assesses their ability to fulfill specified responsibilities

  • Identify patient populations appropriate for the scope of services provided within the department and makes referral to other services as needed based on assessed needs of the patients and the Hospital’s capacity to provide care

  • Identify patient situations indicative of high clinical, financial and/or liability risk

  • Initiate own case management plan for patients/families in assigned caseload

  • Coordinate clinical goals and planning among physicians, patient/family, and multidisciplinary team so that congruence of plans and expected outcomes are achieved

  • Consult as necessary with physicians, patients/family, nursing staff and other disciplines regarding realistic clinical outcomes balanced with resource utilization

  • Initiate and conduct interdisciplinary patient care conferences as necessary to enhance patient care and/or discharge preparation

  • Coordinate internal efforts with external case managers and/or payors

  • Provide education and consultation to patient/family about complex clinical aspects, disposition alternatives, financial options, continuing care options and decision-making or problem-solving issues

  • Participate in outcome measurement activities that include pathway effectiveness, goal attainment, resource management and overall cost assessment

  • Facilitate appropriate clinical documentation to assure that severity of illness and intensity of treatment are accurately reflected in the medical record

  • Improve overall quality and completeness of documentation

  • Prepare initial DRG worksheet and performs concurrent reviews of clinical documentation to reflect diagnosis, procedures, treatments, and changes in patient status throughout the length of stay, discussing and clarifying with physician as needed

  • Review clinical issues with coding staff to assign a working DRG

  • Stay current with, and conducts ongoing clinical documentation management program education for new staff, including new documentation specialists, physicians, nursing and allied health professionals; tracts and trends program compliance

  • Assist in the utilization management process by assessing appropriateness and clarity of intent for patient admission

  • Maintain positive open communication with physicians, interdisciplinary team members, and Department Director

  • Ensure the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes

  • Assist with management of compliant documentation statistical reports

  • Serve as a member of compliant documentation task force/committee

  • Assist with special assignments and projects as assigned in areas of program development

  • Perform Utilization Review on admission, concurrently, and retrospectively

  • Review one day (1) stays and observation admits for appropriateness

  • Perform certification and decertification tasks as they relate to medical necessity

  • Prompt nursing staff and/or physician relative to need for clear physician intent and communicate with Admissions as needed to assure proper intent

  • Meet with charge nurses, staff, social workers daily or as needed to review patient status, identify difficult case situations and potential problem areas

  • Conduct third party reviews by phone or fax, meeting requirements and timetable as defined by case. Performs concurrent and retrospective phone reviews as necessary with third party payers and maintain communication

  • Complete all worksheet information documentation as required

  • Initiate collaborative discussions with physicians to explain patient’s status regarding insurance, intent, limited benefits, stay based on criteria

  • Use Qualis criteria for all utilization review

  • Demonstrate supportive behaviors necessary for age-specific care

  • PERFORM ASSESSMENT FUNCTIONS:

  • Utilize data collected and reported by physician, nursing staff, significant others, other disciplines, and community agencies

  • Use data from chart review and other sources to identify diagnosis, appropriate LOS and any potential outliers

  • Identify payer sources and payer requirements for assessment, data review and communication

  • Identify patient situations indicating high clinical, financial and/or liability risk, decides if patient requires in-depth case management services and retains patient within caseload

  • Evaluate effectiveness and efficiency of current medical and interdisciplinary plan of care for outcomes and resource usage

  • Perform utilization review functions including data collection and outcome measurement

  • Consult with Admitting and Emergency room as needed regarding triage of patients, admitting, diagnosis, appropriateness of admission, best level/location of care, test or service scheduling and other collaborative activities

  • Document when information is provided to a payor and communicates information

  • Document authorizations received and communicates information to appropriate places

  • Communicate concerns with attending physician

  • Complete initial concurrent and retrospective reviews within standard of practice

  • Demonstrate understanding of criteria sets such as InterQual

  • In collaboration with physician and other health care professionals, coordinates, directs and evaluates patient care for the patient population served

  • PERFORM INTERVENTION FUNCTIONS:

  • Coordinate changes in treatments and activities provided within multidisciplinary team to promote patient progress and effective resource use

  • Identify and direct needed changes in nursing interventions and physician processes within the patient’s individualized case management plan to achieve clinical goals and meet financial parameters

  • Initiate and conduct interdisciplinary patient care conferences as necessary to enhance care provision and/or discharge preparation for patient in case load

  • Communicate case management plan to all care providers through changes in plan of care, progress note remarks, and through personal communication

  • Monitor compliance with implementation of plans

  • Participate in physician rounds to enhance continuity

  • Perform certification and decertification tasks as they relate to medical necessity

  • Track physician compliance with utilization review criteria

  • Perform utilization review on all admissions, concurrently and retrospectively

  • Review one day (1) stays and observation admits for appropriateness

  • Prompt Discharge Planners about length of stay concerns

  • Prompt nursing staff and/or physician relative to need for clear physician intent and communicate with Admissions as needed to assure proper intent

  • Meet with charge nurses, staff, social workers daily or as needed to review patient status, identify difficult case situations and potential problem areas

  • Conduct third party reviews by phone or fax, meeting requirements and time table as defined by case

  • Perform concurrent and retrospective phone reviews as necessary with third party payers and maintain communication

  • Complete all worksheet information documentation as required

  • MAINTAIN APPROPRIATE KNOWLEDGE OF JOB:

  • Attend continuing education workshops, seminars, etc, that pertain to job responsibilities

  • Demonstrate knowledge of Medicare and Medicaid regulations

  • PERFORM OUTCOME MEASUREMENT FUNCTIONS:

  • Collaborate closely and seeks input regarding efficient and effective resource use with unit management and staff

  • Participate in outcome measurement activities that include outcome goal attainment, resource management and overall cost assessment

  • Conduct and/or participate in activities of outcome measurement including statistical data collection and systems analysis

  • Present data, analysis, and improvement opportunities to administration and medical staff

  • Perform activities of compliant documentation program

  • Maintain appropriate interpersonal relationships

  • Maintain professional practice, leadership

  • Demonstrate appropriate initiative

Qualifications:

Required qualifications for this position includes:

  • Education -OR- experience in Case Management and/or Utilization Review/Utilization Management

  • Current licensure as a Registered Nurse in the State of Oregon

  • Three (3) years of experience within the area of practice

  • Previous experience in case management; clinical nursing and/or utilization management

Preferred qualifications for this position include:

  • Bachelor's Degree in Nursing

  • Experience in computer technology, laptops, Microsoft Office products

About Providence in Oregon

As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.

The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,

"Providence will provide the best care and service to every person, every time."

Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.

For information on our comprehensive range of benefits, visit:

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Home Health Nursing

Location: Oregon-Mount Angel

Req ID: 267266

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