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RN Case Manager - Oconomowoc - Part Time

Location:  Waukesha
Job Type:  Days - 1st Shift
Weekly Hours:  24

We Are Hiring:  RN Case Manager - Part time benefits elig. .6 FTE   

 

0800-2030,   2-12 hour shifts per week 

 

Begin your story with ProHealth Care. ProHealth Care was recognized in 2020 by Forbes as the best-in-state employer for Wisconsin. The award is a testament to the more than 5,000 employees and providers who have spoken up about their love for their jobs and the work that they do. Enjoy our video series featuring our own employees sharing why they choose ProHealth Care and what they enjoy about working here.

 

At ProHealth Care, we offer a culture that's warm, welcoming, and vibrant. Additionally, we offer a generous benefits plan and resources to help you further your education. After all, it's the way you should be treated.

 

Culture is built every day, and we want you to be a part of this. If you're like us and are passionate about providing exceptional patient care, we'd like to meet you!

Job Summary

Supports the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors.  Integrates and coordinates utilization management, care facilitation and discharge planning functions.  Helps drive change by identifying areas where performance improvement in needed (e.g., day to day workflow, education, process improvements, patient satisfaction).
A proficient practioner who has in depth knowledge of nursing practice, perceives situations as a whole and comprehends the significant elements based on previous experiences.  Recognizes situational changes that require planned and unplanned or unanticipated interventions.
Accountable for a designated patient caseload and plans effectively in order to meet  patient needs, manage the length of stay, and promote efficient utilization of resources.  Specific functions within this role include:
• Facilitation of precertification and payor authorization processes
• Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement
• Application of process improvement methodologies in evaluating outcomes of care
• Support and coaching of clinical documentation efforts and serving as a clinical resource for coders ensuring that documentation accurately reflects severity of illness and intensity of service
• Coordinating communication with physicians.
 
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the patient served.  Must demonstrate knowledge of the principles of growth and development as it relates to the different life cycles.  Specific age groups that are served by this position are circled.
 
A Bachelor's degree in nursing is preferred for this role, but an Associate's degree in nursing is acceptable.

Responsibilities

1. Coordinates/facilitates patient care progression throughout the continuum.
• Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.
• Addresses/resolves system problems impeding diagnostic or treatment progress.  Proactively identifies and resolves delays and obstacles to discharge.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load; monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis:
 completion and reporting diagnostic testing;
 completion of treatment plan and discharge plan;
 modification of plan of care, as necessary, to meet the ongoing needs of the patient;
 communication to third party payors and other relevant information to the care team;
 assignment of appropriate levels of care;
 completion of all required documentation in TQ screens and patient records
 Mobilization of other health care team members to achieve the best personal outcomes.
2. Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
• Struggles with ethical/moral dilemmas in relation with own personal feelings.
3. Utilizes increasing levels of family involvement and participation in goal setting, planning and providing care.
4. Completes Utilization Management and Quality Screening for assigned patients.
• Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Department standards.
• Identifies at-risk populations using approved screening tool and follows established reporting procedures.
• Monitors LOS and ancillary resource use on an ongoing basis.  Takes actions to achieve continuous improvement in both areas.
• Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.
• Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients.  Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.
• Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.
 Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.

 

What You Will Do:

As a member of the Care Management team, the Case Manager (CM) is responsible for facilitation of precertification and payor authorization processes and status determination at the point of entry in to the hospital from outpatient areas including cath. lab, day surgery and physician offices. This position will proactively prevent denials through assessment and application of Milliman Care Guidelines to determine status for appropriate reimbursement and bed placement. RN CM also facilitates collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement. RN CM's actively participate in the discharge planning process for all patients working collaboratively with payors, providers, patients and families.

 

Ideal candidate possesses:

Excellent communication and negotiation skills

Strong analytical and computer skills with prior EPIC experience helpful

Experience with pre-acute and post-acute care, as well as, community based resources

Ability to work independently and collaboratively with the care providers and business office staff is necessary

Promotes safety, cost efficiency and a commitment to quality improvement.

 

What you will need:

Associate's Degree in Nursing (BSN in nursing preferred)

Current Wisconsin RN license required

Current Basic Life Support (BLS) certification

Why Join ProHealth Care: 

We have nearly 5,000 dedicated clinical and non-clinical employees and physicians who work together every day to serve the health and well-being of our community. At ProHealth Care everyone contributes to the care our patients receive. And, everyone is treated with kindness and respect in our welcoming environment.

 

This Position Will Offer You:

  • Engaging and community focused culture
  • Competitive Salaries
  • Opportunity for professional career growth
  • Robust benefits including: Generous PTO; Choices in insurance; HSA; Tuition reimbursement; immediate 401K match; discounted tickets to various entertainment, social and sporting events

 

ProHealth Care is an equal opportunity employer and is committed to an inclusive work environment and values the perspectives of our people. We maintain a drug-free workplace and perform pre-employment substance abuse testing. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

 

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Do You Fit at ProHealth Care?

Here at ProHealth Care, we strive to be the best we can be, while continually improving the care we deliver. With patient care at the center of all we do, it is ingrained into our culture to attract the best and the brightest to ProHealth Care. We have a promise to our patients and employees: The way you should be treated. We live by this commitment and remain dedicated to creating a warm, safe and welcoming environment.


Nearest Major Market: Waukesha
Nearest Secondary Market: Milwaukee