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Providence Health & Services Admissions Nurse Case Manager (RN) - Utilization Review in Missoula, Montana

Description:

Providence is calling a Admissions Nurse Case Manager (RN) (Utilization Review) (1.0 FTE, Days) to St. Patrick Hospital in Missoula, Montana. We are a community of caregivers delivering every day on our Mission to provide compassionate care that is accessible for all – especially those who are poor and vulnerable.

Apply today! Applicants that meet qualifications will receive a text with some additional questions from our Modern Hire system.

In this position you will:

  • Responsible to assess all ED and other unplanned patient admissions during work hours.

  • Assessment parameters to include identifying medical necessity criteria, corresponding correct registration status, and discussing findings with admitting provider when indicated by review.

  • Review all status orders for patients to a bed from procedural areas including, but not limited to, Surgery, CVL, Endoscopy and Radiology to verify correct status order and related medical necessity as appropriate.

  • Under the direction of the department Manager, is also responsible for directing an organized, patient-centered interdisciplinary team system that coordinates the delivery of healthcare services by continually monitoring, evaluating, and modifying the treatment plan to achieve optimal patient outcomes and efficacious use of resources.

  • Coordinate with physicians, other Nurse Case Managers Social Worker, and other health team members to expedite medically appropriate, cost-effective care and promote quality through evidence based medical practice throughout the health care system.

  • Address variance findings through research, planning and system improvement using IDT approach incorporating LEAN methodologies.

  • Continuously assess, develop, and implement discharge patient/family needs and work with appropriate healthcare provider to procure necessary services.

  • Coordinate finalization of all discharge related recommendations when appropriate.

  • Demonstrate caring and involved behaviors to patient/family members and play an advocacy role to ensure positive outcomes.

  • Develop and direct continuum of care map in collaboration with interdisciplinary team.

  • Document avoidable days/delays with attributions as identified when appropriate.

  • Effectively communicates and involves patient/family in discharge planning. when appropriate.

  • Facilitate case finding to refer conversation regarding end-of-life decision making and attempt to reduce the frequency of artificially prolonged and painful dying by eliciting preferences, improving understanding of outcomes, encouraging attention to pain control, advance care planning, and patient-physician communication.

  • Facilitate maximum access to benefits to meet discharge need when appropriate.

  • Identify internal and/or external resources and refers appropriately to meet patient needs when appropriate.

  • Identify possible situations of abuse, neglect or exploitation utilizing knowledge of physical and psychosocial indicators of abuse.

  • Make referral calls to appropriate agencies.

  • If case is not encountered, then must attend at least one educational session on this topic, and provide documentation of attendance.

  • Identify obstacles to efficiency and goal outcomes and intervene to overcome or eliminate these when possible as documented by Avoidable/Unavoidable Days reported.

  • Identify, monitor and collaborate with IDT for timely completion of patient education when appropriate.

  • Maintain clinical competency and current knowledge of financial, regulatory, and payer requirements to perform job responsibilities.

  • Maintain the security and confidentiality of data and information used in the performance of his/her daily duties conforming to hospital policy, laws and regulations as appropriate.

  • Negotiate with healthcare agencies for services as needed.

  • Participate in identified LEAN/change activities.

  • Participate in UM/UR data collection in relation to topics identified by Utilization Management Committee.

  • Provide completed tracking tools as specified for aggregation and department report to as requested.

  • Possess knowledge of institution/payer policies, procedures and the law and uses that knowledge appropriately.

  • Promote optimal allocation of healthcare services through effective and efficient use of resources across continuum of care.

  • Provide education regarding healthcare and social resource systems to empower patient/family to access resources independently.

  • Serve as a resource to healthcare team throughout healthcare system in promoting clinical guidelines.

  • Use and document level of care criteria and length of stay /anticipated day of discharge expectations for all patients assessed and being placed within the hospital.

  • Use and document level of care criteria for all patients within their assignment and documents status recommendatio

Qualifications:

Required qualifications for this position include:

  • Graduate of an accredited school of nursing or Graduate of an accredited health information technology program.

  • Current licensure in the State of Montana as a Registered Nurse.

  • Three (3) years current clinical hospital experience, or Nursing Management experience, or previous experience as a Case Manager.

Preferred qualifications for this position include:

  • Current Case Manager Certification.

About the hospital you will serve.

St. Patrick Hospital in Missoula, Montana has more than 250 licensed beds and serves patients from 17 counties. We have been recognized as a Thomson Reuters Top 100 Hospital and among many other awards, have earned the Premier Award for Quality award repeatedly. Missoula is halfway between Yellowstone and Glacier National Park. It is a university city of 65,000, surrounded by big sky, scenic mountains, forests and renowned rivers.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://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: Case Management

Location: Montana-Missoula

Req ID: 303868

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