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RN Case Manager, Nights-Indirect Patient Care

Company: Banyan Medical Systems
Location: Omaha
Posted on: January 15, 2019

Job Description:

COMPANY BACKGROUND

Banyan Medical Systems, Inc. is headquartered in Omaha, Nebraska. We design, develop, produce, sell, and support custom Healthcare IT solutions. Our work focuses on the integration of real-time data streams in support of providing care givers, patients, and family members access to coordinated, holistic care information. We currently offer configurable solutions for procedural area integration (e.g. operating rooms), fall prevention, virtual care teams, and multi-source audio/video collaboration. In addition, we offer scalable custom solutions for addressing room to enterprise level collaboration needs. Banyan Medical Systems is an innovative Digital Healthcare provider looking for dynamic, energetic, accountable, and highly self-motivated individuals to join our team.

LOCATION AND HOURS

Managed Services Operation Location: Omaha, NE

3 Nights a week: 6:00 p.m. to 6:00 a.m.

SUMMARY

Banyan Medical Systems is looking for professionals in the healthcare field who can learn the Banyan products and provide virtual care services to the Managed Services Clients. As a member of the Managed Services team, the Virtual Case Manager will coordinate the plan of care and provide comprehensive care coordination and oversight of patient's care remotely on the Managed Services Clients' inpatient unit(s). The RN Virtual Case Manager, in collaboration with members of the inter-disciplinary healthcare team, leads the development and implementation of the multidisciplinary plan of care for patients, determining appropriate patient status and level of care; ensuring effective quality and cost-efficient outcomes by performing concurrent and retrospective case review, and supervising the provision of the discharge plan of care. This position functions as the key linkage between the physician, staff, and hospital leadership in the day-to-day management of appropriate and efficient patient care and functions as an advisor to the physician with accountability to escalate cases to the Medical Director (as necessary) to ensure the provision of appropriate and effective patient care.

The Virtual Case Manager will collaborate with the multidisciplinary team, including Physicians, Registered Nurses, technicians, and other healthcare providers, for care coordination, education and virtual assessments on admission and discharge. The Virtual Case Manager will also be responsible for monitoring quality metrics specific to the department and ensuring complete and accurate documentation in the patient record of the data collected for those metrics. A high degree of professional competence and autonomy will be demonstrated in performing the roles of 1) clinician, 2) educator, 3) consultant/collaborator, and 4) navigator.

The Virtual Case Manager is responsible for the assessment, planning, implementation, coordination, monitoring and evaluation of the patient's plan of care from admission to post-discharge. The Virtual Case Manager utilizes clinical knowledge, critical thinking skills, and the principles of case management to coordinate and implement a discharge plan that meets the patient's needs and ensures a seamless, effective, and efficient transition of care across the continuum.

PREREQUISITE SKILLS: Case Manager

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Must have the ability to read, write, and follow English verbal and written instructions, and have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, and positive personal influence and negotiation skills.

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Leadership skills to delegate, functionally supervise, provide direction/guidance to staff and hold others accountable are required.

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Must have the ability to work independently with a minimum of direction, anticipate and organize work flow, prioritize and follow through on responsibilities.

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Must have strong clinical assessment and critical thinking skills necessary to provide utilization review/discharge planning services appropriate to patients with complex medical, emotional and social needs.

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Strong attention to detail and accuracy is required.

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Must have the ability to work in a high-volume case load environment and deal effectively with rapidly changing priorities.

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Demonstrated ability to work constructively with a broad spectrum of health care professionals is required.

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Must be assertive and creative in problem solving, system planning and management.

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Proficient computer skills are required including use of Electronic Health Record and other IT applications.

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Must be effective as both a team member and a leader.

KNOWLEDGE

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General knowledge of supervisory principles/applications is required.

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Must have a working knowledge of disease processes, current treatments and their physical and psychosocial sequelae.

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Knowledge of individual and family development over the life span is required.

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Knowledge of the influence of cultural and spiritual values on health care is required.

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Basic knowledge of applicable laws, regulations, and accreditation guidelines (e.g. CMS, DHS, Joint Commission, EMTALA) is required.

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Basic knowledge of government and private insurance benefits (e.g. Medi-Cal, Medicare, DRGs, managed care, capitation), including reimbursement requirements is needed.

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Must know child, elder and dependent adult and domestic violence reporting requirements.

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General knowledge of available health care and community resources appropriate for populations served is required, broad/in-depth knowledge is preferred.

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Working knowledge of Inter-Qual criteria.

ESSENTIAL FUNCTIONS (not modifiable) Care Facilitation and Coordination:

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Coordinates care for an assigned unit-based patient population in a paired team model comprised of RN Case Manager and MSW Social Worker.

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Works with the multi-disciplinary healthcare team to ensure the plan of care is expedited and barriers to efficient throughput are identified and corrected.

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Creates a plan of care that outlines the key interventions and outcomes to be achieved each day of the inpatient stay. "Plan for the day - plan for the stay"

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Can actively lead multidisciplinary case conferences in developing comprehensive, cost-effective case management plans that span the continuum.

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Makes independent assessments and recommendations regarding course of action in complex situations and recommendations relevant to multi-system or special needs Patients.

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Identifies and refers quality and risk management concerns to appropriate level for corrective action plans and trending.

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Proactively solicits physician's orders for services.

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Demonstrates knowledge and skills necessary to provide cultural, spiritual and age specific care by obtaining specific care information and assessing relevant information needed to identify each patient's unique treatment and discharge planning needs

Utilization Management Specific Interventions

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RN Case Manager completes an admission review using standardized criteria (Inter-Qual) within 24 hours of admission and documents review outcome.

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Escalates to the Physician Advisor when criteria are not met and attending physician disagrees with findings.

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Completes a continued-stay review according to policy to assure patient is at the appropriate level of care.

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Monitors the length of stay in comparison with MS-DRG/GMLOS for all patients.

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Completes concurrent review for specified health plans and includes medical necessity documentation to avoid payor denials.

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Ensures that the patient is transitioned to the next level of care as quickly as possible once the patient no longer meets clinical criteria for the current level of care.

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Works with physicians and CDI to ensure that clinical information available in the medical record is accurate and reflects the care rendered to the patient.

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Collaborates with physicians to determine appropriate levels of care for post hospital care, use of hospital resources, and available community resources.

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In a timely manner, communicates pertinent information to third-party payers and managed care organization to obtain authorization for care and prevent denials.

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Reviews, processes, and issues denials to client/responsible party following regulatory guidelines and facility protocols. Informs client/responsible party of right of appeal and the appeal process. Collects data for the appeals process.

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Identifies avoidable days, intervenes to correct delays, and enters outcomes in MIDAS in a timely manner according to policy and procedure.

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..... click apply for full job details

Keywords: Banyan Medical Systems, Omaha , RN Case Manager, Nights-Indirect Patient Care, Healthcare , Omaha, Nebraska

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