Kadlec Nursing Jobs

Job Information

Kadlec Case Management Specialist RN - CRM in Richland, Washington

Description:

Kadlec has an exciting opportunity for a Case Management Specialist RN to join our growing Clinical Resource Management team located in Richland, Washington!

Shift Details: Full time, 1.0, Day Shift

Qualifications:

Minimum Requirements:

  • Graduation from an accredited nursing program

  • Current Washington State RN Licensure

  • Current American Heart Association Healthcare Provider BLS

Preferred Qualifications:

  • Bachelor’s Degree in Nursing from an accredited educational institution.

  • Two (2) years recent inpatient clinical experience in an acute care facility

  • Previous Case Management, discharge planning or utilization review experience

  • Bi-lingual or multi-lingual skills

Duties include, but are not limited to, the following:

As a Case Management Specialist RN you will provides clinically-based case management to support the delivery of efficient patient care. Has the overall accountability for the integrated responsibilities of case management; utilization management, discharge planning, facilitation and coordination of care. Collaborates with other members of the health care team to identify appropriate utilization of resources and to ensure reimbursement. Utilizes criteria to confirm medical necessity for admission and continued stay. In conjunction with the patient, family and healthcare team, creates a discharge plan appropriate to the patients' needs and resources.

  • Demonstrate and sustain compliance with Kadlec Caregiver Expectations Standard of Excellence and Code of Conduct

  • Complete an initial screen of all patients within 24 hours of admission utilizing InterQual criteria to identify needs related to utilization management and/or discharge planning. Refers appropriate cases to Social Work based on established referral criteria and professional judgment

  • Introduce self to the patient/family, explains the Specialist, Case Management –RN role, and provides patient/family with a business card

  • Integrate the discharge planning/coordination and utilization review functions in the case management role

  • Collaborate with all members of the multidisciplinary team to facilitate the case management and care coordination processes for the assigned caseload

  • Evaluate patients for appropriateness of admission type and setting, utilizing a combination of clinical information, screening criteria, and third party information

  • Validate admission criteria with third party payers (including onsite and telephonic Case Management Specialists) as well as Primary Care and Attending Physicians. Recommends alternative care sites where appropriate

  • Administer HINN’s (Hospital Issued Notices of Non-Coverage) as appropriate

  • Identify cases that fail to meet criteria and promptly reviews the case with the patient’s physician to resolve the issue

  • Refer unresolved cases to the Director, Clinical Resources Management by 3 p.m. of the same day

  • Collaborate with the third party payers to anticipate denial of payment and proactively addresses issues contributing to a potential denial

  • Address denials by reviewing the patient record and case management worksheets. Writes the letter of appeal for pertinent denials

  • Cover other areas as needed and requested

  • Identify high risk patients to promote coordination of services and to prevent readmissions or Emergency Department visits. Strategizes with Primary Care Physicians, attendings, specialists, and payers to develop appropriate care delivery strategies for these patients

  • Document in the patient record according to department policies and procedure

  • Complete the Case Management Specialist worksheet with accuracy on a daily basis

  • Communicate promptly with attending physicians when cases lack adequate documentation to support acute hospitalization

  • Contact the attending physician to notify him/her of all decisions to issue a notice of non coverage for all payers

  • Inform the patient and/or next of kin when Medicare coverage must be terminated for the current admission. Issues the determination letter for Medicare patients following established hospital policy

  • Develop a strategy with the Director, Clinical Resources Management to address situations in which a third party payer is issuing a termination of benefits notice

  • Educate staff and physicians about managed care principles, observation services, discharge planning, reimbursement rules and range of patient care settings beyond observation, intensive care and acute hospital levels

  • Seek and provide peer consultation about cases that are presenting problems and/or experiencing significant deviation from the plan of care

  • Participate in quality improvement and evaluation processes related to the case management practice

  • Participate in the development of procedures, roles, systems, and structures related to the case management practice

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://kadlec.jobs/benefits-information/

Our Mission

Provide safe compassionate care. We promise to answer the call of every person we serve; to know them, care for them and ease their way. We are committed to safety, compassion, respect, integrity, stewardship, excellence and collaboration.

About Us

Located in sunny Tri-Cities, WA, Kadlec is the largest non-profit healthcare provider in the region. Kadlec is the premier choice for customer service excellence, providing compassionate healthcare by combining cutting-edge technology and innovation with evidence-based, patient-focused care. Kadlec does not unlawfully discriminate on the basis of race, sex, sexual orientation, age, color, religion, national origin, genetic information, marital status, veteran status, disability status, or any other characteristic protected by Federal, State, or Local Law. EOE. To learn more, click here: https://kadlec.jobs/about-us/

Schedule: Full-time

Shift: Day

Job Category: Case Management

Location: Washington-Richland

Req ID: 317527

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