Case Management - RN Case Manager - Full Time - 1st Shift Job Listing at Wilson Health in Sidney, OH (Job ID 8a7883a88df2152f018e1ba622c75de3)

Description

Wilson Health is looking for a direct hire RN Case Manager for our Case Management department in Sidney, Ohio (North Dayton, Ohio) area.

Key Perks and Benefits:

• EDC clinic offering free primary care, prescriptions, labs/testing, and wellness visits.
• Sick Leave (Company provided Short Term and Long Term Disability)
• Insurance (Medical, Dental, Vision, Prescription, Company Provided Group Life Insurance)
• PTO (Full Time PTO starts accruing on Day one)
• Retirement (Generous 401k match starting on day one)
• Education Reimbursement (Tuition & Book Fee Reimbursement up to $3,500 per calendar year)

Employment Status:  Full Time

Working Hours: 40 hours a week (80 hours per pay period)

Shift: 1st Shift   

Position Reports to: CFO

Department Description: Wilson Health's Case Management Department is responsible for the process of development and implementation of a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual's and family's comprehensive health needs. These needs are met  through communication and available resources to promote patient safety, quality of care, and cost.

Job Summary:  Coordinates the patient's care and service delivery across the health care continuum.   Works collaboratively with interdisciplinary team both internal and external to the organization to improve patient care through effective utilization review and monitoring of health care resources and assumes a leadership role to achieve desired clinical, utilization and resource outcomes  Addresses and resolves patterns in variances that have a negative quality/cost impact. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.  

• Perform concurrent and retrospective review function by evaluating the medical necessity, appropriateness, and cost-effectiveness of patient care plans and procedures in compliance of Utilization Review Plan.
• Routinely rounds with physicians as appropriate.
• Analyzes treatment plans and alternatives, formulates the most appropriate plan for the continuum of care, and coordinates the activities of professional staff, agencies, suppliers and family members in achieving planned outcomes.
• Develops, implements, monitors, and modifies the plan of care for the patient through a collaborative and interdisciplinary team approach.
• Assists and collaborates with the healthcare team in locating community resources and linking patients to the most appropriate agencies, facilities, etc.  Makes referrals to Social Service when appropriate.
• Functions as a resource for physicians, nursing, and ancillary staff concerning estimated length of stay, avoidable hospital days, and discharge planning needs.
• Facilitates discharge planning efforts through early identification.  Ensures that each discharge has attainable goals and that all elements of the patient's needs are addressed in the plan. 
• Assesses the patient's physical, psychological, functional, social, environmental and financial status and goals.  Advocates for the patient, family, physician and facility to obtain benefits from insurance carriers and others that provide financial assistance for patients.
• Monitors the patient's progress towards outcomes and makes recommendations as to the continuation of services.
• Participates in daily care conference.
• Tracks and reports trends of inappropriate resource utilization
• Assists in data gathering and analysis and makes recommendations for process improvements.  Participates and supports QAPI projects throughout the institution. 
• Maintains a current working knowledge of third party payor guidelines and review criteria.  Keeps abreast of current regulatory requirements for Case management, Medicare, Medicaid, and Ohio KEPRO. Works in accordance with current state, federal and unique requirements of third party payors.

Qualifications:

• Graduate of an accredited school of nursing (BSN Preferred)
• Minimum of three (3) years clinical hospital experience and two (2) years case management/utilization review experience preferred.
• Case Managers primarily assigned to Emergency Department prefer 1 year ED experience.

Mission & Vision & Values:

• Improve the health and wellness of the community by delivering compassionate, quality care.
• Be a trusted, nationally-recognized leader of innovative, collaborative, community health.
• A.S.P.I.R.E - Always serve with professionalism, integrity, respect, and excellence.

EOE (Equal Opportunity Employer)

 Apply on company website