Job Description

RN Case Manager - Mount Graham Regional Medical Center
Job CategoryNursing
ScheduleFull time
Shift1 - Day Shift

Job Description

Our Mission

We Are Caring People Committed to Improving Community Health.

Expectations at MGRMC

  • < > is about commitment. At MGRMC, we will:

    Make every patient and visitor's satisfaction a top priority.

  • Go beyond the minimum required.

  • Do all that is required to ensure a safe and secure environment within our hospital.

  • Demand 100% effort from ourselves in everything we do while accepting nothing less from those we work with.

  • < > - Our Attitude defines who we are. At MGRMC, we will:

    Recognize that our attitude is an expression to others of our character and integrity.

  • Recognize that our attitude we carry as we approach our day to day tasks will inevitably drive our behavior.

  • Have a pleasant attitude that underscores our principles of caring and compassion towards those we serve.

  • Perform with an understanding that our organization, and each person who makes up our organization, will succeed as far as our attitude takes us.

  • < > - A Compassionate gesture to a patient, a visitor or a fellow co-worker can be the difference between a positive or a negative experience. At MGRMC, we will:

    Approach our duties with a sense of Compassion.

  • Show empathy to those who are struggling.

  • Provide comfort when comfort is needed.

  • Recognize that every person, whether patient, visitor or co-worker, deserves the same treatment that we would want for ourselves.

  • < > is the life blood of any organization. At MGRMC, we will:

    Strive to have full transparency, when possible, between Administration, Management and Staff.

  • Expect everyone to take responsibility for receiving information that has been communicated.

  • Provide clear, concise and timely information to our patients.

  • Exhibit positive body language when communicating.We will listen with our eyes and our ears.

  • Provide any instruction, feedback or criticism with tact.

  • < > is the standard by which every organization is judged. At MGRMC, we will:

    Be current in all educational aspects of our professions.

  • Remain courteous at all times, especially in situations where discourteousness may seem the natural reaction.

  • Exhibit the appearance, demeanor and grooming of one who belongs to a professional organization.

  • Recognize the effect of our actions in front of non-staff members.What may be acceptable to an audience of co-workers, may not be acceptable to an audience of patients or visitors.

  • < > is a staple of any successful relationship. At MGRMC, we will:

    Recognize we are all one team in search of a common goal that will elude us if sought separately.

  • Treat everyone (patients, visitors and co-workers) equally.

  • Respect the privacy of others that we value for ourselves.

  • Make time to praise and not just find time to criticize.

  • Use hospital funds with prudence.

  • Accountability - Holding people Accountable for their actions is the only way to guarantee our organization is living up to its Mission, Vision, and Value. At MGRMC, we will:

    • Take responsibility and ownership for assignments that are given.

    • Respect and established organizational chain of command.

    • Be reliable in all our duties and expectations.

    • Accept feedback and implement it.

    • Always adhere to our 4A process for Service Recovery.(Anticipate,Acknowledge, Apologize and Amend)

    • Expect to be held accountable to these Performance Standards.

Position Summary

Under the general supervision of the Director of Quality, the Case Manager is responsible for daily planning, coordination, and monitoring of patient care across the continuum.  Case Manager is responsible for developing care on the assigned caseload, accountable for assuring effective use of available resources, maintaining established standards of care and meeting outcomes within an appropriate length of stay.  Ensures that variations based on patients’ individual needs are justified and well documented.

Required Qualifications

  • Must be at least18 years of age.

  • Proof of highest level of education completed but not less than high school education or equivalent.

  • Graduate from an approved school of nursing.

  • Current Arizona Registered Nurse License.

  • Minimum two years RN acute care experience

  • Maintains current CPR Certification from the American Heart Association (Healthcare Provider) or other approved educational programs.

  • Ability to establish and maintain effective working relationships with all levels of MGRMC personnel.

  • Ability to establish and maintain positive communication with patients and family under stressful situations.

  • Ability to effectively communicate in oral and written form.

  • An understanding of computer systems, process design and data management.

  • Must have a well-groomed, professional appearance.

  • Must have the mental and physical ability to perform, with or without reasonable accommodation, the essential functions of the job.

  • Ability to lift, carry, pull, & push 50 pounds.

  • Language proficiency in English, with excellent written and verbal fluency.

Preferred Qualifications

  • Minimum two years RN case management experience in a critical access hospital
  • Bachelor’s degree or certification.

  • Knowledge of discharge planning and utilization review processes.
  • Knowledge and understanding of social service needs.

  • Knowledge of coding process.

  • Previous Meditech experience or other related electronic records systems.

Principle Clinical/Technical Duties

Category: Core Competencies

 

  • Manages individual patients and at-risk patients across the health care continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes.

  • Acts in a leadership function to collaboratively develop and manage the care transition patient discharge plan, and, effectively communicates the plan across the continuum of care.

  • Identifies, coordinates and communicates a care management plan according to patient’s needs in such areas as social and economic data, age-specific criteria, family resources, functional abilities, knowledge needs, potential risk factors, complications and special issues to achieve expected outcomes, satisfaction with services and post-discharge planning needs and documents in patient medical record.

  • Conducts medical record reviews evaluating the utilization of facilities and services for appropriate levels of patient care. Performs and communicates the reviews to meet organizational and payor requirements.

  • Assists in assurance of optimal reimbursement from third party payors by providing concurrent and retrospective reviews of admissions, readmissions, observations and transfers.

     

    Category: Patient Care

  • Assess, coordinates, negotiates, procures and facilitates the utilization of resources for patients to achieve high quality and cost-effective outcomes. Assists, and facilitates, in the identification, research, isolation and resolution of potential utilization/resource management problems.
  • Serve as patient and family advocate; engages patients, family and caregiver to be active participants in their care and assists them in navigating the healthcare system.
  • Assesses, plans, implements, coordinates, monitors and evaluates for appropriate disposition, collaborating with the healthcare team to formulate and achieve a cohesive, comprehensive discharge plan. Identifies issues that may delay patient discharge and facilitates resolution of these issues.

Category: Teamwork

 

  • Establishes and promotes collaborative relationships with physicians, payers, and other members of the health care team to achieve expected outcomes.

  • Facilitates and participates in health care team meetings.
  • Evaluates and updates ongoing assessments and discharge needs of patient care needs through frequent rounds and communication and provides education, information, direction and support to patient/client family, caregivers, and multidisciplinary healthcare team members as it relates to the care goals for the patient.
  • Evaluates the medical necessity and appropriateness of care utilizing standard criteria. Collects and communicates pertinent information to payors and others to meet utilization goals.
  • Collaborates with admitting physician to place patient in approval level of care status utilizing current evidence-based knowledge, orders, protocols and criteria for data based decision-making skills and facilitates utilization of regulatory guidelines that promote appropriately controlled resource utilization. 
  • Actively participates in the recovering of denials of payment process and issuance of denial letters with physician assistance.
  • Assists with swing bed program.

 

Category: Other Duties

 

  • Educates internal members of the health care team on case management and managed care concepts; facilitates integration of concepts into daily practice.

  • Maintains current knowledge of regulatory discharge planning guidelines and case management standards.

  • Participates in internal/external continuing education and quality improvement activities.

  • Serves on hospital committees as requested.

  • Other duties as assigned.

 

This is a general description of the kinds of duties and responsibilities that are performed by employees who have this title.  It shall not be construed as an all-inclusive determination of the specific duties and responsibilities of any particular position.  It is not intended in any way to limit the right of any supervisor to assign, direct and control the work of employees under his/her supervision.

 

Working Conditions

  • Good lighting, air-controlled work area in a confined space with frequent interruptions, and pressure to meet deadlines. Interactions involve patients, family, health care professionals, and outside agencies. Job duties involve no exposure to blood, body fluids or tissue during the normal work routine, but employment may require performing unplanned Category I tasks that involve exposure to blood, body fluids, or tissue.

Adherence to Policies & Procedures

 

  • Consistently applies knowledge of policies/procedures in departmental performance.Recognizes and appropriately responds to deviations from departmental policy/procedure.

  • Adheres to the 7 Performance Standards

     

Age-Appropriate Interventions

 

  • Demonstrates knowledge and appropriate measures with consideration of cognitive/physical/emotional/ biological maturation level, in meeting needs of population served, as it relates to age-appropriate intervention.

 

Safety

 

  • Demonstrates knowledge of MGRMC safety policies/procedures contributes to a safe/secure work environment for everyone and initiates effective actions in response to potential and actual safety hazards.

 

 

 

 

Application Instructions

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