Case Manager / RN

Overview

Join our team as a day shift, full-time, Case Management Acute Care Registered Nurse (RN) in Pocatello, ID.


Why Join Us?


Thrive in a People-First Environment and Make Healthcare Better

• Thrive: We empower our team with career growth opportunities, tuition assistance, and resources that support your wellness, education, and financial well-being.
• People-First: We prioritize your well-being with paid time off, comprehensive health benefits, and a supportive, inclusive culture where you are valued and cared for.
• Make Healthcare Better: We use advanced technology to support our team and enhance patient care.

Get to Know Your Team:

• Portneuf Medical Center is a nationally recognized healthcare leader with 205 beds, serving as the region's tertiary care and Level II Trauma Center, housing the Portneuf Heart and Vascular Institute, Portneuf Cancer Center, Portneuf Medical Group, and Portneuf Air Rescue.

Responsibilities

The Case Manager RN is responsible for assessing and coordinating patient care across the continuum, utilizing accepted criteria and guidelines to manage benefits and determine the medical necessity of the services provided. This position functions to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization. The Case Manager RN reports to the Director of Case Management or designee.


Essential Functions

1. Act as a patient and caregiver advocate.
2. Work with the entire healthcare team to improve the quality of patient care, patient safety and customer service.
3. Act as a good steward of the patient's healthcare resources and the resources of the hospital.
4. Screening and assess patients for needs using a standard tool.
5. Create a discharge plan of care based on identified needs.
6. Coordinate care to ensure consults, tests, and procedures are performed in a manner appropriate and consistent with patient choice and resources.
7. Communicate in both written (in the medical record) and oral fashion all contributions to the progression of care in a way that is easily understood by the patient, the caregiver, the healthcare team, and the payer.
8. Use compliant and ethical behaviors to ensure that federal, state, hospital, and patient self-determinations are met.
9. Assist the patient to transition to the next level of care in a timely manner with recognition given to readmission risks and appropriate post-discharge interventions are established.
10. Ensure that community resources are readily known, and patients are provided with a choice of post-acute providers.
11. Balance the responsibility of patient advocacy with stewardship of hospital resources.
12. Use the hospital defined method to ensure the patient is in the appropriate status and level of care throughout the continuum of care.
13. Follow the hospital utilization management process in respect to payer requirements for timely notification and communication of pertinent clinical data to support the admission, as well as continued stay and post-discharge needs of a patient.
14. Identify and track avoidable days/delays and use the information as an opportunity for improvement.
15. Work proactively to prevent medical necessity denials, assist in the appeal process if a denial is received and escalate the process as needed.
16. Keep current and abreast of regulatory requirements effecting role and responsibilities.
17. Excellent interpersonal and communication skills to build and foster collaborative partnerships using a team approach to span traditional boundaries within the health care setting.
18. Must be highly motivated with a positive attitude and high degree of flexibility in a rapidly changing environment.
19. Demonstrated ability to deliver accurate results on time and efficiently with a customer-focuses approach.
20. Demonstrated ability to change priorities quickly, work independently and multi-task without hesitancy.
21. Excellent written and verbal communication, complex problem solving and team leadership skills.

Qualifications

Job Requirements:

• Current RN license
• BLS certification must be obtained within 14 days of hire or transfer into the role and prior to providing direct patient care.

Preferred Job Requirements:

• 2+ years' acute hospital based nursing experience.
• Experience in acute care hospital case management.
• Certification in case management (ACM or CCM).