Case Management RN

Company: Star Valley Health
Location: Afton
Posted on: October 23, 2024

Job Description:

Description:SummaryWhile upholding the Star Valley Health mission, vision, and values, this key position is responsible for the effective management and operation of the utilization review and discharge planning endeavors. As advocates for the patients, you will also navigate the medical system and help patients and families understand their options. The responsibilities encompass compliance with CMS and state regulations and the overall direction of the quality management program. This will require keeping abreast of current medical laws, rules, and policies such as Medicare, Medicaid, and other health insurance. This position requires the ability to manage medical costs through timely prospective, concurrent, and retrospective review activities. This is an at-will position.Job DutiesContributes to Quality Management program goals and objectives in containing health care costs and maintaining a high-quality medical delivery systemCommunicates directly with physicians to gather all clinical information to determine the medical necessity of requested healthcare servicesReviews inpatient and outpatient services using Milliman Care GuidelinesRecommends, coordinates, and educates providers, patients, and families regarding alternative care optionsServes as a liaison and patient advocate when deemed applicable for quality of care and cost outcomesPromotes alternative care programs and researches available options including costs and appropriateness of patient placement in collaboration with insurance carriersParticipates in quality improvement activitiesWorks with staff/employees to analyze the patterns and trends to identify and determine whether a problem or opportunity for improvement exists Continual monitors of high risk and problem-prone areasIdentifies and reduces risks of acquitting and transmitting infections among patients, employees, physician, and other independent practitioners, contract workers, volunteers, students, and visitorsDevelops, reviews and updates policies and procedures based on nationally recognized standardsAssists with projects and tasks in the Quality Department as neededPerforms other duties as assigned or needs ariseRequirements:RequirementsAbilities & Skills:Strong communication, documentation, clinical and critical thinking skills essentialStrong multi-tasking skills with the ease of changing directions upon request and needsInterpersonal and problem-solving skills necessary to interact with physicians, Board, leadership, employees, and the publicAbility to work in a team-oriented environment, communicate effectively, and demonstrate sensitivity to patients, visitors, and staffPromote a cooperative and congenial work environmentProficient in Microsoft Office products such as Word, Excel, and Outlook. General Internet skills and use of a computer for clinical data entry/retrievalComply with HIPAA and other federal, state and local regulations as well as maintain the highest degree of confidentiality in patient and staff mattersConstant sitting, standing, walking, pushing, pulling, bending, reaching, and computer use throughout the dayExperience & Education:Current Wyoming RN or LPN license5 years of clinical experience in a hospital setting preferredWorking knowledge of utilization management preferredNote: Position descriptions are intended to serve as a guideline for typical duties and requirements of a position, but are not inclusive. Additional or different responsibilities within a reasonable scope of the position description may be added or deleted any anytime at the discretion of the Board.Compensation details: 33.68-50.54 Hourly WagePIc77d8ca4bc42-25660-35202965

Keywords: Star Valley Health, Pocatello , Case Management RN, Executive , Afton, Idaho