RN- Case Manager w/ Utilization Review Experience!

Position Summary:

The Registered Nurse Non-Certified Case Manager works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. Ensures patient is progressing towards desired outcomes by monitoring care through assessments and/or patient records. Identifies and resolves barriers that hinder effective patient care. Actively involved in discharge planning process.

Minimum Qualifications:

Required

• Montana Licensure (Registered Nurse)
• American Heart Association BLS
• Minimum of 2 years of nursing experience
• MUST HAVE UTILIZATION REVIEW EXPERIENCE

Preferred

• Bachelor s Degree in Nursing
• 2 years of acute care hospital experience as a case manager

Essential Job Functions:

In addition to the essential functions of the job listed below, employees must have on-time completion of all required education as assigned per DNV requirements, Bozeman Health policy, and other registry requirements.

• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member case load for regular outreach and management.
• Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for members.

Knowledge, Skills, and Abilities

• Demonstrates sound judgement, patience, and maintains a professional demeanor at all times
• Ability to work in a busy and stressful environment
• Strong interpersonal, verbal and written communication skills
• Exercises tact, discretion, sensitivity and maintains confidentiality
• Computer applications, MS Office, EMR, internet applications and standard office equipment
• Ability to analyze, organize and prioritize work while meeting multiple deadlines
• Strong emotional intelligence, interpersonal and teamwork skills

Schedule Requirements

• This role requires regular and sustained attendance.
• The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts.
• On-call work may be required to respond promptly to organizational, patient, or employee needs.

Physical Requirements

• Lifting (Repeatedly 50 pounds): Exerting force occasionally and/or using a negligible amount of force to lift, carry, push, pull, or otherwise move objects or people.
• Sit (Occasionally): Maintaining a sitting posture for extended periods may include adjusting body position to prevent discomfort or strain.
• Stand (Repeatedly): Maintaining a standing posture for extended periods may include adjusting body position to prevent discomfort or strain.
• Walk (Repeatedly): Walking and moving around within the work area requires good balance and coordination.
• Climb (Rarely): Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like using feet and legs; may also use hands and arms.
• Twist/Bend/Stoop/Kneel (Repeatedly): Twisting, bending, and stooping require flexibility and a wide range of motion in the spine and joints.
• Reach Above Shoulder Level (Repeatedly): Lifting, carrying, pushing, or pulling objects as necessary above the shoulder, requiring strength and stability.
• Push/Pull (Repeatedly): Using the upper extremities to press or exert force against something with steady force to thrust forward, downward, or outward.
• Fine-Finger Movements (Continuously): Picking, pinching, typing, or otherwise working primarily with fingers rather than using the whole hand as in handling.
• Vision (Continuously): Close visual acuity to prepare and analyze data and figures and to read computer screens, printed materials, and handwritten materials.
• Cognitive Skills (Continuously): Learn new tasks, remember processes, maintain focus, complete tasks independently, and make timely decisions in the context of a workflow.
• Exposures (Continuously): Bloodborne pathogens, such as blood, bodily fluids, or tissues. Radiation in settings where medical imaging procedures are performed. Various chemicals and medications are used in healthcare settings. Job tasks may involve handling cleaning products, disinfectants, and other substances. Infectious diseases are caused by contact with patients in areas that may have contagious illnesses. Emotionally challenging situations, such as dealing with distressed patients or difficult family interactions.