Case Management RN

Description:SummaryWhile upholding the Star Valley Health mission, vision, and values, this key position is responsible for the effective management and operation of the utilization review and discharge planning endeavors. As advocates for the patients, you will also navigate the medical system and help patients and families understand their options.

The responsibilities encompass compliance with CMS and state regulations and the overall direction of the quality management program. This will require keeping abreast of current medical laws, rules, and policies such as Medicare, Medicaid, and other health insurance. This position requires the ability to manage medical costs through timely prospective, concurrent, and retrospective review activities. This is an at-will position.Job DutiesContributes to Quality Management program goals and objectives in containing health care costs and maintaining a high-quality medical delivery system

Communicates directly with physicians to gather all clinical information to determine the medical necessity of requested healthcare services

Reviews inpatient and outpatient services using Milliman Care GuidelinesRecommends, coordinates, and educates providers, patients, and families regarding alternative care options

Serves as a liaison and patient advocate when deemed applicable for quality of care and cost outcomes

Promotes alternative care programs and researches available options including costs and appropriateness of patient placement in collaboration with insurance carriers

Participates in quality improvement activities

Works with staff/employees to analyze the patterns and trends to identify and determine whether a problem or opportunity for improvement exists Continual monitors of high risk and problem-prone areas

Identifies and reduces risks of acquitting and transmitting infections among patients, employees, physician, and other independent practitioners, contract workers, volunteers, students, and visitors

Develops, reviews and updates policies and procedures based on nationally recognized standards

Assists with projects and tasks in the Quality Department as needed

Performs other duties as assigned or needs arise

Requirements:RequirementsAbilities & Skills:Strong communication, documentation, clinical and critical thinking skills essential

Strong multi-tasking skills with the ease of changing directions upon request and needs

Interpersonal and problem-solving skills necessary to interact with physicians, Board, leadership, employees, and the public

Ability to work in a team-oriented environment, communicate effectively, and demonstrate sensitivity to patients, visitors, and staff

Promote a cooperative and congenial work environment

Proficient in Microsoft Office products such as Word, Excel, and Outlook. General Internet skills and use of a computer for clinical data entry/retrievalComply with HIPAA and other federal, state and local regulations as well as maintain the highest degree of confidentiality in patient and staff matters

Constant sitting, standing, walking, pushing, pulling, bending, reaching, and computer use throughout the day

Experience & Education:Current Wyoming RN or LPN license5 years of clinical experience in a hospital setting preferred

Working knowledge of utilization management preferred

Note: Position descriptions are intended to serve as a guideline for typical duties and requirements of a position, but are not inclusive. Additional or different responsibilities within a reasonable scope of the position description may be added or deleted any anytime at the discretion of the Board.Compensation details: 33.68-50.54 Hourly WagePI630bcd706df6-25660-35202965