Monitors and manages patient care to promote continuity of care, optimal patient outcomes, patient satisfaction, cost efficiency, and compliance.
Case Management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes. The case manager conducts a comprehensive assessment of the client’s health needs in order to develop a plan of care. The case manager plans with the patient, the primary care physician, other health care providers, the payer, and the community to maximize health care response and quality, cost-effective outcomes.
Consults with nursing staff and multidisciplinary team regularly to evaluate patient's status andappropriateness of medical care, including admission, length of stay, transfer and discharge.
Monitors patient and family satisfaction. Responds to questions and complaints from patients, family members, and payors regarding care.
Participates in discharge planning including coordinating patient transfers to other facilities and coordinating community resources. Provides discharge education and resource referrals to patients.
Performs chart review to identify actual or potential issues with service delivery, patient outcomes and satisfaction, compliance, cost, and reimbursement.
The case manager educates the patient and members of the health care delivery team about case management, the health care and treatment options, community resources, insurance benefits, psychosocial concerns, etc., so that informed decisions can be made.Problem-solves, exploring options to care when available and alternative plans when necessary to achieve desired outcomes. The case manager encourages appropriate use of health care services and strives to improve quality of care and maintain cost-effectiveness on a case-by-case basis.RN Case manager is an advocate for both the patient and the payer to facilitate positive outcomes for the patient, the health care team, and the payer. However, when a conflict arises, the needs of the patient must be the priority.This position is responsible for utilization review activities including insurance requests for clinical information, receiving and communicating authorization numbers and changing the admission status according to medical necessity and physician orders.To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation.
JOB FUNCTIONS:Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is a logical assignment to the position. This position description does not restrict the right of management to assign or reassign duties and responsibilities with and without notice.
High school diploma or equivalent x Preferred
X Associate’s degree □ Preferred X Required
X Bachelor’s degree X Preferred □ Required
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Basic Life Support (BLS) RequiredAny other certifications are acceptable and welcomedIf employee has ACLS, BLS is NOT required)
Registered Nurse from an accredited schoolIf not already Case Management certified, must sit for appropriate certification within 30 month of hire (if all other criteria is met)
Must possess the ability to delegate tasks to subordinate team members and oversee their performance. Must have strong interpersonal, oral and written communication skills. Effective human relations skills are required for interfacing with team members, all levels of staff, physicians, patients, families and other contacts. Must possess the ability to effectively function in a stressful environment.
Active RN license in good standing with the Arizona State Board Of Nursing. Compact licensure is also acceptable.
*Minimum Work Experience*
Minimum of 3-5 years in Case Management/Utilization Review preferred
**Job:** **Case Management/Social Services*
**Organization:** **Valley View Medical Center*
**Title:** *RN Case Manager - PRN*
**Location:** *Arizona-Ft. Mohave*
**Requisition ID:** *7451-3118*
While all employers are vetted to meet the Maricopa Guidelines, the job postings are not individually reviewed. Students should be diligent in ensuring they are applying for positions that meet their needs and are not in violation of the Maricopa guidelines.