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Care Manager
Regional Health
Regional Health
 

Job Location: Rapid City, SD
Job Type: Full time
Hours: Scheduled Weekly Hours

40


Department: RCRH Care Management
Scheduled Weekly Hours:
40
Shift:
Day (United States of America)

Job Summary:

Provides clinically based care management to support the delivery of effective and efficient patient and family centered care in the acute care hospital setting. Responsible for collaboration with medical staff, patients, family and the health care team by assessing, facilitating, planning and advocating for health needs on an individual basis resulting in quality, cost-effective outcomes. Determines realistic goals and coordinates efforts to ensure smooth discharge planning and clear follow up after discharge. Utilizes InterQual criteria guidelines to confirm medical necessity for admission and continued stay. Establishes goals and priorities consistent with the mission and goals of Rapid City Regional System of Care, as well as meet requirements of JCAHO and other applicable federal, state and local regulatory and/or accrediting bodies. Collaborates with medical staff and the interdisciplinary team to promote quality patient outcomes. Performs follow up discharge call with in 48 hours.

Job Description:

Essential Functions:
  • Applies up-to-date information related to reimbursement procedures, managed care contracts and patient status in facilitating/collaborating in the plan of care.
  • Coordinates the provider aspect of federal/state organization functions as detailed in the Conditions of Participation and other appropriate regulations.
  • Supports compliance with Utilization Review and regulatory guidelines. Identify trends related to compliance of regulations and collaborates with appropriate hospital personnel and external agencies to ensure appropriate process changes are implemented.
  • Supports the Medical Staff Quality Review process by identification of issues related to quality indicators set forth by the Medical Staff.
  • Creates and updates the Plan of Care (POC) to include patient/family-centered goals with interventions that reflect the changing needs of the patient/family unit and is consistent with their current needs and desires.
  • Maintains a working knowledge and relationship with community resources and payer benefits that link the individual with the most appropriate resources. Assists by maintaining expertise on benefits, reimbursement and contract/regulation changes per payer guidelines, Medicare and Medicaid to facilitate appropriate reimbursement, education and guidance to assist the healthcare team and patient/family in decision making.
  • Facilitates planning for patient/family needs to ensure a smooth transition for the patient across the continuum of care.
  • Evaluates current treatment plan to identify barriers, determine realistic goals and objectives, and seek potential alternatives in conjunction with the medical staff. Coordinates team efforts with support services departments to ensure appropriate care and smooth discharge transition.
  • Is a visible resource on the unit and coordinates interdisciplinary team huddles/communication, identifying and communicating the patients health care needs based on the best practice standards to ensure care and communication needs are met in relation to both internal and external providers/services, ancillary department services, core measures, compliance with internal policies/regulatory guidelines and True North metrics.
  • Performs follow-up phone calls to patients within 48 hours of discharge and triages patients/family calls up to the first outpatient follow-up visit. Confirms follow up appointments are made and coordinates further communication/clarification with providers as indicated.

    Additional Requirements:

    Lifting no more than 20 pounds at a time, with frequent lifting or carrying of objects weighing up to 10 pounds. May require a good deal of walking or standing, and/or may require sitting most of the time with some pushing/pulling of arm or leg controls.
  • Standing-Frequent
  • Sitting-Frequent
  • Walking-Frequent
  • Talking-Constant
  • Driving-Ocassional
  • Balancing/Climbing-Occasional
  • Stooping/Kneeling-Occasional
  • Crouching/Crawling-Occasional
  • Reaching-Frequent
  • Hearing-Constant

    Qualifications:

    Registered Nurse (RN) - South Dakota Board of Nursing - South Dakota Board of Nursing

    Employee Benefits:
    Regional Health offers a highly competitive and comprehensive benefits package that looks out for you and your family. We recognize there are many types of families, with many different needs. That's why our plans are flexible, allowing you to select the individual benefits which fit your personal needs.

    Regional Health is an integrated health care system with the purpose of helping patients and communities live well. The organization, with headquarters in Rapid City, S.D., provides community-based health care in more than 20 communities in two states and 32 specialty areas of medicine. As the largest private employer in western South Dakota, Regional Health is comprised of five hospitals, 24 clinic locations and employs nearly 5,000 physicians and caregivers. Regional Health is committed to the future of medicine, with medical training partnerships, a medical residency program, and more than 130 active research studies.

    How to Apply:





    Regional Health

    Come join us in our pursuit to become the best healthcare system in America!
    Regional Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.

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