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RN Case Manager

Robbinsdale, MN

About North Memorial Health

At North Memorial Health, you're part of an inclusive health family that is rooted in our values of relationships, inventiveness, and accountability. Empathy and care are at the heart of North's culture which is designed to actively support each team member's wellbeing and growth. Our strength lies in our diversity, and we embrace the unique contributions and experiences of each person. Together, we empower customers to achieve their best health.

About this position

The case manager provides clinically-based care coordination to support the delivery of quality customer care as efficiently as possible. The case manager is accountable for individual customers ensuring quality clinical outcomes, appropriate resource management, and discharge planning for customers within an assigned caseload. With the customer, family and health care team, the case manager creates and organizes a discharge plan for medically complex customers appropriate to the customer's needs and ensures that the customer is receiving the right care, at the right level across the continuum. In addition, the case manager must know the disease, the trajectory of illness, the treatment plan, the standard of care for the diagnosis, the expected outcome and the length of stay (LOS) for the case type. Case Manager is responsible for progression of care of all customers and must assist the Interdisciplinary Team in determining appropriate LOS, appropriateness of setting, medical necessity and status.

 

What we’ll expect from you

• Identifies needs related to clinical outcomes, complex care coordination, and transition/discharge planning on medically complex customers.
• Identifies potential barriers to discharge or transfer and partners to spearhead resolution of the issues where possible.
• Collaborates to establish target LOS and effectively manage discharge plans.
• Participates and leads in customer/family care conferences to facilitate transition planning and care coordination.
• Follows-up with customer and/or family post discharge as indicated to ensure appropriate disposition and follow-up care.
• Works in collaboration with the physicians, physician advisors, members of the healthcare team and payors to address all issues in a timely and effective manner.
• Identifies consistent/chronic issues related to quality care, utilization and discharge planning and communicates them to the department leadership, seeking solutions and supporting improvements in systems to enhance care.
• Identifies customers and families with complex psychosocial concerns and refers them to the Social Worker as appropriate.
• Leads daily care rounds to facilitate care coordination and transition/discharge planning. Participates in other interdisciplinary customer care plan meetings as indicated.
• Partners with members of the healthcare team to develop standardized care boards/care plans/ clinical protocols/pathways to achieve appropriate and timely care delivery.
• Responds to customer/family concerns by working collaboratively with hospital customer representatives.
• Performs Admission, Continued, and Extended Stay Reviews to aid in determining admission status, appropriateness of setting, and medical necessity.
• Ensures customers are placed in the appropriate level of care and addresses any issues related to status and clinical appropriateness on a concurrent and retrospective basis.
• Reviews medical records regularly throughout stay to ensure customer continues to meet severity of illness and intensity of service criteria for acute hospitalization.
• Collaborates/communicates with external payors and case managers.
• Communicates reimbursement information to customers and families as appropriate; ensures plan consensus with customer/family and payors.
• Assists in the appeals/denial management process by investigating and responding to payor denials.
• Collaborates with the Compliance Department to maintain current working knowledge of all relevant compliance risks/issues and rules/regulations. Maintains awareness of relevant payor requirements, restrictions and reimbursement methods.
• Applies approved clinical appropriateness criteria (e.g., InterQual) to monitor appropriateness of admissions and continued stays, and documents findings based upon department standards
• Accepts other duties as assigned to promote the accomplishment of organizational goals.
• The team member is accountable to demonstrate proficiency for the skills outlined in the appropriate position skills list.
• The team member is accountable to maintain skill proficiency, including improvement where deemed necessary, and upgrading any additional or new skills on the appropriate position skills list. • Recognizes and complies with legal, regulatory, accrediting and procedural requirements related to area of responsibility.
• Understands and follows principles and standards as outlined in North Memorial's Corporate Code of Conduct.
• Protects customer and team member privacy and only accesses customer and/or team member related information as needed to perform job duties.
• Reports violations or areas of concern to supervisor or Corporate Compliance Officer via established methods of communication.

• Understands and follows principles and standards as outlined in North Memorial's Corporate Code of Conduct.
• Protects customer and team member privacy and only accesses customer and/or team member related information as needed to perform job duties.
• Reports violations or areas of concern to supervisor or Corporate Compliance Officer via established methods of communication.
• Recognizes and complies with legal, regulatory, accrediting and procedural requirements related to area of responsibility.
• Understands and follows principles and standards as outlined in North Memorial's Corporate Code of Conduct.
• Protects customer and team member privacy and only accesses customer and/or team member related information as needed to perform job duties.
• Reports violations or areas of concern to supervisor or Corporate Compliance Officer via established methods of communication.

Interested? Here are our requirements

Education

• Graduate from an accredited school of nursing required; BSN or BAN preferred.   

Experience, Knowledge, Skills, Abilities 

• Three to five years previous acute care nursing experience preferred.
• Hospital case management and utilization management experience preferred • Knowledge of current case management principles, utilization management, length of stay management and/or transition/discharge planning highly preferred.
• Excellent verbal and written communication skills required.
• Knowledge of current nursing principles, techniques and procedures required.      

Licensure/Certification(s) Mandatory

Current RN license in the State of Minnesota - State Requirement

Licensure/Certification(s) Mandatory where Applicable

    

Licensure/Certification(s) Preferred

    

Posting Date:


EEO/AA STATEMENT

North Memorial Health is an equal employment and affirmative action employer. North Memorial Health does not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, age, disability, genetic information, marital status, veteran status, sexual orientation, gender identity, creed, status with respect to public assistance, or other protected class status. North Memorial Health provides reasonable accommodation to disabled applicants and employees and takes affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to protected class status. If you believe that you have been treated in a way that does not conform to these statements, please contact our HR Service Center: 763-581-6947. If you need a reasonable accommodation, due to a disability, or to assist with the application process, please contact our HR Service Center: 763-581-6947.


INSPECTION OF AAP
North Memorial Health is a Federal government contractor or subcontractor.
As a part of our obligations under law, we must develop a written Affirmative Action Program for Individuals with Disabilities and Protected Veterans, as specified by law (AAP).
This AAP is available for inspection by applicants and employees in the Human Resources Office during normal business hours.
Link to Policy



North Memorial Health

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A culture of unmatched customer service

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A culture of unmatched customer service

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A culture of unmatched customer service

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North Memorial Health has always provided an equal opportunity for me to excel within this organization while pursuing a passion to help others with the support of a true team!Robert, North Memorial Health Pharmacy Technician

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