The RN in our Care Management department specializes in
assessing hospital admissions for status per defined criteria and
reviews for appropriate utilization of resources. Ensures
continuity and coordination of care for patients before, during and
after hospitalization, and ensures that payer conditions are
In conjunction with the interdisciplinary team supervises
progress and recommends appropriate clinical interventions to
nursing staff and attending physicians, ensuring CMS guidelines are
In conjunction with the interdisciplinary team ensures that
patients and families have access to resources for post-hospital
Monitors patients' medical progress, identifies and addresses
patient needs/gaps in service as they move through the system, and
obtains authorization for discharge planning as appropriate. Takes
action to correct variances in length of stay by following up with
physicians and payers as needed.
Provides utilization reviews, meeting all time requirements and
addresses the discharge appeal process in collaboration with the
physician, Dir/Mgr and/or Social Worker.
Performs other duties as assigned.
License, Certification, Education or Experience:
REQUIRED for the position: Current State of Washington RN
license, Bachelors of Science degree in Nursing or be actively
pursuing a degree in Nursing. Three (3) years of experience as an
RN with a combination of acute care and/or case management
experience. Current American Heart Association Healthcare Provider
BLS certification by date of hire. Knowledge of the healthcare
financial environment, reimbursement and levels of care. Knowledge
of community resources and how to access them effectively and
efficiently. Interpersonal skills necessary to lead and coordinate
an interdisciplinary team and deal effectively with patients and
families from a variety of backgrounds and with varied emotional
and medical needs. Age-appropriate developmental assessment skills.
Excellent communication skills to ensure and deliver safe patient
care and to provide a legal record of this care. Accountability for
professional nursing practice, commitment to patient care and
commitment to uphold the Patient Bill of Rights.
DESIRED for the position: Master's degree in Nursing or other
experience and /or educational preparation that would provide the
foundation for Nursing Case Management