RN Case Manager – Care Coordination

Swedish Medical Center is looking for a RN Case Manager (0.0 FTE, Days) to work in Care Coordination at Swedish Edmonds in Edmonds, WA. The RN Case Manager is responsible for clinical case management functions via a collaborative process that transitions patients to optimal clinical outcomes while assuring safe, cost-effective care. Demonstrates a daily commitment to the department’s value of teamwork. In this position you will: * Clinical Essential Functions: * Performs new admission assessments within designated time frames. * Facilitates/supplements the staff nurse role in reviewing, interpreting, integrating and analyzing patient clinical findings. Communicates clinical findings and care recommendations effectively and collaboratively to achieve targeted outcomes. * Ensures consistent standard of care including the physician specific plan of care is followed for all patients. Assures appropriate tests and treatments to the diagnosis are completed. Ensures referrals for medical consults are completed in a timely manner. Identifies “Captain of the Ship” in complex cases with multiple practitioners. * Intervenes clinically, as appropriate, proposing alternatives to ensure a cost effective and efficient plan of care that meets clinical and regulatory standards. Provides supportive and therapeutic clinical interventions as indicated. * Evaluates and facilitates documentation * Psychosocial Essential Functions: * Identifies risk factors and/or strengths of patient/family support system on admission and refers/communicates to appropriate team members. Identifies abuse/neglect and refers appropriately for evaluation and reporting. * Assures ethical situations are identified and makes referrals to Medical Ethics Committee as indicated. * Ensures advance directives are in place and honored according to the patient’s wishes. * Identifies primary patient/family decision maker and communicates care plans as indicated. Initiates and participates in patient/family conferences as needed. * Financial and Utilization Management Essential Functions: * Maintains knowledge of particular reimbursement methods and communicates reimbursement information to patients, families and the healthcare team. * Ensures patients are placed in the appropriate level of care according to the clinical situation and prescribed plan of care. Screens for continued medical necessity and level of care. Assures approved days from payers. * Pre-screens for financial issues surrounding admissions and transfers. Refers patients to financial counselor for information and to implement financial assistance forms. * Maintains awareness of payer contract requirements. Collaborates with managed care contracting staff on elements of plan performance and contract requirements. Conducts utilization review activities as required by managed care contracts. * Issues and explains extended stay denials. Reviews impending denials with physician advisor. Assists with information to support appeal of any business office denials. Researches clinical denial claims and writes appeal letters. * Documents findings in patient medical record. Monitors avoidable delays and days. * Maintains awareness of interqual guidelines and DRG length of stay standards. Required qualifications for this position include: * Nursing Baccalaureate degree (BSN) from an accredited school of nursing required. Applicants without a BSN degree must actively pursue and attain a BSN within five years of hire. Continued employment by Swedish beyond five years is contingent upon attaining the BSN degree. Registered Nurses employed by Swedish prior to December 1, 2012 are encouraged to pursue the BSN degree, but obtaining the degree will not be a condition of employment * Current Washington State Registered Nurse License * Case Management Certification required at hire or within 2 years of eligibility * Three (3) years current relevant clinical experience Preferred qualification for this position include: * Hospital-based case management experience About the Edmonds Campus: Swedish/Edmonds (formerly Stevens Hospital) has been providing sound and thoughtful care for patients in the greater Seattle area for more than 45 years. We pride ourselves in employing only the most qualified and caring professionals. We are not simply a hospital or a workplace. We are a family. We are a community. Our mission is to improve the health and well-being of the community through local, high-quality and compassionate health care services. On Sept. 1, 2010, Stevens joined the Swedish family and became Swedish/Edmonds to create an innovative, regional health-care delivery network that provides more local services, while giving residents greater access to the latest medical treatments and the comprehensive services of the Swedish system. The Swedish/Edmonds campus includes: * 217 licensed beds * 450 of the most qualified physicians and specialists on medical staff * 1,400 staff including clinical and non-clinical personnel * Full scope of medical and surgical services, including Level IV Trauma emergency medicine, diagnostic, treatment and support services