RN Care Manager

Mackinac Straits Health System is recruiting an RN Care Manager to join our Acute Care team!

Description: This position will provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The goal of the position is to enhance the quality of: patient management and satisfaction, to promote continuity of care and cost effectiveness through the integrating of the functions of case management, utilization review and discharge planning. This position has accountability for the coordination of discharge planning of all Acute Care patients. This position reports to the Acute Care Manager.

Summary:

Attends and assists with leading daily interdisciplinary care meetings and rounds with Provider as needed

Leads Comprehensive Community Care meetings to network with other local agencies, as needed.

Leads Utilization Review Committee (DNV requirement)

Attends Community Focus group for networking of services, difficult patient/community concerns, as needed.

Weekly check in meetings with Acute Care Manager.

Daily assessments of all patients and develops, monitors and evaluates patient treatment plans, facilitates interdisciplinary team (IDT) plans of care, educate patients, and promotes self-management goals .

Supervises the overall care delivery process and follow up to ensure plans of care/treatment goals are being met.

Reviews history and physicals, daily progress notes in detail and follows up with physicians for improved utilization of services.

Daily review of Important Message for Medicare (IMM) and Medicare Outpatient Observation Notice (MOON) for compliance (DNV requirement) and assists with obtaining signatures and compliance.

Daily analysis of admission data, including physician compliance/quality indicators, readmissions, extended stays, Interqual and MCG guidelines compliance, Medicare/Medicaid compliance, incomplete medical records and follows up with appropriate personnel to help facilitate improved processes.

Prepares comprehensive discharge planning- including evaluating discharge (DC) plans, arranging alternative DC placement, coordinating DC services, providing resources and education/training to patients and families.

Improves financial status through daily utilization review and recommending changes to policies, procedures, etc.

Orders durable medical equipment (DME) and educates patients on use of DME.

Promotes enhanced quality of care and cost-effective interventions and outcomes.

Reviews swing bed referrals and coordinate care to admit.

Reviews daily insurance prior authorizations.

Daily insurance reviews.

Daily insurance re-certification reviews.

Write appeal letters for insurance denials.

Coordinate with providers to improve insurance approval through peer to peer conversations with insurance companies.

Facilitate communications between care providers throughout multiple agencies and team members.

Ensure that all Admission and Discharge policies and procedures are in compliance with CMS guidelines to ensure insurance reimbursement.

Daily post-discharge follow up calls.

Assist patients in navigating the health care system- coordinating specialty care, follow up, and other care coordination needs.

Home health and hospice referral coordinator.

Meets routinely with other entities (ie: Hospitals, LTC facilities, Home Health companies) to promote admissions, and transfers for Swing Bed patients, etc.

Coordinates with Emergency Department staff for discharge needs and resources for patients seen in the Emergency Department and assists as needed with Emergency Department patient social issues.

Help floor nurses with any patient care needs, as available.

Help Emergency Department with triage and any trained/assigned duties, as available.

Creation and review of policies

Performs chart reviews

Assists with planning and implementation of quality projects

Assists with development and implementation of clinical pathways

Assists with staff development with new service offerings, as needed

Qualifications:

• Registered nurse with Michigan licensure.
• Minimum of 3 years of Acute Care clinical practice experience required.
• Organization, prioritization, communication skills (verbal, interpersonal, and written), customer relations and basic computer skills.
• Certification in case management preferred
• Demonstrated ability to work collaboratively within a multidisciplinary team.

Job Type: Full-time

Pay: From $75,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Health insurance
• Health savings account
• Life insurance
• Paid sick time
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance

Work Location: In person

Salary : $75,000