RN Case Manager

ABOUT SHERIDAN MEMORIAL HOSPITALSheridan Memorial Hospital is a progressive, state-of-the-art facility nestled beneath the Big Horn Mountains in beautiful Northeast Wyoming. Founded over 100 years ago, Sheridan Memorial is licensed for 88 beds with over 60 physicians who provide primary medical care and specialty care in more than 15 areas. We are proud of our more than 700 employees who provide personalized, patient-centered care in a healing environment. When people think of excellent healthcare, they think of Sheridan.

The goal of the RN case manager is to educate high risk patients on their diagnosis, disease process and medications, as well as be a liaison with the patient’s physicians in identifying any potential gaps in care or understanding. The RN case manager will communicate with physicians/manager/co-workers, as appropriate about changes in patient’s clinical condition including results of diagnostic studies and symptomatology, and is able to respond quickly and accurately to changes in condition or response to treatment.

• Serves as a resource for facilitating patient transfers, including, but not limited to, obtaining or providing clinical information from/to the referring/accepting facility. Performing clinical reviews of all inbound transfers for appropriateness.
• Identification of high risk social issues and referral to social worker case manager
• Monitors use of healthcare resources. Communicates with providers to assure patient receives diagnostics/evaluations in the proper setting, i.e. inpatient vs. outpatient
• Actively participates in the multidisciplinary team meetings.
• Identifies and documents delays in service.
• Serves as an expert resource to physicians and healthcare staff in the application of InterQual criteria and the use of evidence-based practices.
• Follows department policy regarding escalation of utilization issues to the provider or his/her designee.
• Determine patients at risk for re-admissions, as identified by the discharge assessment at the time of admission.
• Rounds with providers as a team on patients as appropriate.
• Education of patients regarding their diagnosis and disease.
• Begin discharge teaching and education on admission. Documentation of discharge teaching in the EMR.
• Facilitates meeting patient’s needs with their provider in a timely manner.
• Knowledge of medications and their correct administration based on age of the patient and their clinical condition.
• Ability to formulate and revise an individualized plan of care as indicated by the patient’s response to treatment. Evaluates overall plan daily for effectiveness.
• Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning. Family is included in teaching as appropriate.
• Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs.
• Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic and religious/spiritual needs of patients and their families.
• Functions as liaison between the patient/family, physicians, other healthcare providers and administration.
• Interacts professionally with patient/family and involves patient/family in the formation of the plan of care.
• Documentation meets current standards and policies.
• Identifies and addresses psychosocial needs of patients and family; communicates with social service /discharge planner regarding both in hospital and post discharge needs.
• Coordinates/facilitates patient care progression throughout the continuum of care.
• Works collaboratively and maintains active communication with providers, nursing and other members of the disciplinary team to effect timely, appropriate patient management.
• Addresses/resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Collaborates with the provider and all members of the multidisciplinary team to facilitate care for designated case load; monitors the patient's progress, intervening as necessary and appropriate to ensure the plan of care and services provided are patient focused on a timely basis:

• Completion and reporting of diagnostic testing
• Completion of treatment plan and discharge plan
• Modification of plan of care as necessary to meet the ongoing needs of the patient
• Communication to third party payer and other relevant information to the care team

MINIMUM REQUIREMENTS

Education/Experience/Licenses

• Current unrestricted Wyoming Registered Nurse License.
• Bachelor's degree in nursing or related field with case management experience, preferred.
• 3-5 years recent hospital based patient care or relevant experience.
• 3-5 years Milliman or InterQual experience, preferred.
• HMO, managed care, PPO, Utilization Management/medical management experience preferred.
• BLS certification required.

Additional Skills

• Strong computer skills.
• Excellent communication skills; able to communicate effectively both verbally and in writing.
• Strong team building, leadership, and conflict resolution skills.
• Proficiency with use of conditional code 44 and code W2.
• Current knowledge of CMS rules and regulations.

Sheridan Memorial Hospital is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability or protected veteran status. If you would like more information about your EEO rights as an applicant under the law, please click here.

Specific demands not listed: Possible exposure to blood and or body fluids / infectious disease / hazardous waste requiring the use of Personal Protective Equipment. Exposure to odorous chemicals / specimens and Latex products

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Pre-employment drug and alcohol screening is required.