RN Case Manager - Utilization Review

• Utilization Review at INTEGRIS Health, Oklahoma City, OK.

Get to Know Your Team

* INTEGRIS Health, Oklahoma’s largest not-for-profit health system, is seeking
a dedicated caregiver to join us in our mission to partner with people to
live healthier lives.  

* Benefits of being an INTEGRIS Health caregiver include front-loaded PTO,
medical benefits through the extensive INTEGRIS Health network, financial
assistance for continued education, 24/7 mental health support and more.  

* Take the first step toward growing your career by joining us.  

Responsibilities

The RN Case Manager responsibilities include, but are not limited to, the
following:

* Completes a comprehensive assessment of patients clinical, psychological and
financial needs utilizing all available resources.
* Recommends and coordinates timely transfers to appropriate levels of care as
indicated by clinical needs and utilization criteria.
* Develops, implements, evaluates and revises, as necessary, a plan for
discharge, including referrals to other health care and community
organizations based on needs assessment.
* Communicates discharge care plan, and any changes in the plan to patient,
family and all appropriate healthcare professionals.
* Assists physicians and hospital staff in appropriate utilization of resources
through application of utilization criteria and facilitating timely discharge
planning for patients.
* Coordinates services between hospital departments to facilitate timely
patient discharge.
* Conducts concurrent review of patient records on admission to the hospital
and as determined by the patient's clinical condition.
* Applies utilization criteria accurately in order to determine appropriate
utilization of resources.
* Notifies designated internal and external contacts of utilization issues that
may affect patient care and/or reimbursement. 
* Facilitates patient transfers to other health care organizations in
accordance with hospital policies and all-applicable state and federal
guidelines and regulations.
* Acts as a resource/advisor to physicians regarding discharge planning,
medical record documentation, and all issues that may affect resource
utilization and reimbursement.
* Integrates and manages established pathways, where available, to enhance
clinical effectiveness and clinical resource management.
* Maintains knowledge and understanding of CMS regulations, Medicare/Medicaid,
managed care and other payer regulations and benefit limits.
* Acts as a resource and provides education for patients, their family members
and all health care professionals regarding HCFA regulations, Medicare,
Medicaid, managed care and other payers.
* Develops and maintains knowledge and understanding of hospital and community
resources, and facilitates use of most appropriate level of care to conserve
patient, hospital, and payer resources.
* Identifies opportunities to reduce cost of managing patient care without
impacting quality or outcomes.
* Participates in collecting and recording data for utilization and Quality
Improvement reporting. * Works collaboratively and professionally with
patients, family members, and physicians, hospital staff and other
individuals and agencies involved in providing patient care.

Qualifications

Required Qualifications

Experience

* 2 years experience in a clinical settings (e, g. home health, inpatient,
physician office, clinic)

License/Certifications

* BLS (Basic Life Support) Issued by American Red Cross or American Heart
Association within 30 days of hire
* RN (Registered Nurse) Current licensure as a Registered Nurse (RN) in the
State of Oklahoma or current multistate license from a Nurse Licensure
Compact (eNLC) member state

Skills

* Excellent interpersonal communication and collaboration skills
* Computer experience

Must be able to communicate effectively in English (verbal/written). This job
requires the incumbents to operate a INTEGRIS-owned vehicle OR personal vehicle
(non INTEGRIS-owned) and therefore must have a current Oklahoma State Drivers
License as well as a driving record which is acceptable to our insurance
carrier.

Preferred Qualifications

Experience

* Experience with managed care and payer/provider requirements

Education

* Bachelor's of Science in Nursing

License/Certifications

* Case Management Certification

INTEGRIS Health is an Equal Opportunity Employer. All applicants will receive
consideration regardless of membership in any protected status as defined by
applicable state or federal law, including protected veteran or disability
status.

INTEGRIS Health mission: Partnering with people to live healthier lives.

To our patients, that means we will partner to provide unprecedented access to
quality and compassionate health care. To you, it means some of the state's best
career and development opportunities. With INTEGRIS Health, you will have a
genuine chance to make a difference in your life and your career.

INTEGRIS Health is the state's largest Oklahoma-owned health system with
hospitals, rehabilitation centers, physician clinics, mental health facilities
and home health agencies throughout much of the state.