Case Manager RN/Registered Nurse - Waukesha, WI

Optum
US - Wisconsin - Eau Claire
November 19, 2024

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives.
The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.
Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities.
Come make an impact on the communities we serve as you help us advance health equity on a global scale.
Join us to start Caring.
Connecting.
Growing together.

The Case Manager RN is responsible and accountable for coordination of patient services through an interdisciplinary process, which provides a clinical and psychosocial approach through the continuum of care.
Through concurrent case management, patients will be assessed to determine appropriateness of admission, continued hospitalization, as well as appropriate level of care.
Case Managers facilitate timely care delivery at the right time, in the right setting, by following CMS guidelines, escalation of operational barriers, and collaboration with all stakeholders.
Discharge planning will begin at the time of (or prior to) admission, and reassessed ongoing throughout the course of hospitalization in partnership with the clinical team, the patient, and/or the patient's representative.
Quality and Risk Management issues will also be monitored and reported as appropriate.

Location:
Waukesha Memorial Hospital - 725 American Ave, Waukesha, WI

Schedule:
Monday - Friday - 8 AM - 4:
30 PM CST - Can be flexible - Every 6th Weekend

Primary Responsibilities:

Takes lead role in directing disposition of patients and utilization considerations
Assumes leadership role to facilitate interdisciplinary collaboration
Effectively problem-solves and actively pursues resolution
Directly communicates with staff, physicians, patients, and families
Role models leadership behavior through courtesy, respect, and efficiency
Coordinates patient care processes to achieve desired quality outcomes and identifies/controls inappropriate resource utilization
Facilitates patient and family education and promotes continuity of care to achieve optimal patient outcomes.
Assures patient rights by offering a choice when appropriate
Reviews the patient plan of care with the multi-disciplinary team.
Facilitates and participates in multi-disciplinary team care conferences for patients with complex problems.
Communicates in the medical record and verbally with the team to coordinate interventions and facilitate continuity of care
Daily communication and collaboration with the patient care staff to provide continuous assessment, evaluation, and continuum planning to assure the patient receives the appropriate level of care at the appropriate time
Functions without direct supervision, utilizing time constructively and organizing assignments for maximum productivity.
Arranges schedules to facilitate meetings with physicians for patient care rounds, team meetings and other opportunities to improve communication
Ability to effectively read, write, and speak, cognitively process and emotionally support performing other duties as assigned
Basic Microsoft Office Skills
All employees are expected to remain flexible to meet the needs of the hospital, which may include floating to other departments to assist as patient needs fluctuate
Must be able to functionally coordinate and discharge plan for all age groups, including but not limited to the unborn child through geriatric age groups
The CM will be responsible for integrating the assessment of the need for post-hospital services and determination of an appropriate discharge plan for complex cases
Educates patient/family as to options/choices within the level of care determined to be appropriate.
Initiates and ensures completion of all necessary paperwork
Facilitates completion of orders as required prior to transfer of patient to the next level of care in a timely manner so discharge is not delayed
Continuum of Care planning will emphasize education and collaboration with physicians, family members, clinical social workers, nursing staff, therapists, and case managers from contracted payors when appropriate to determine discharge plan that will be of maximum benefit to the patient.
Involve staff from the next level of care in the treatment plan as early as possible to promote continuity and collaboration
Develop care plans for patients who frequent the Emergency Department in partnership with the patient's physician, ED Provider, and community resources
Knowledge of all applicable federal and state regulations.
Shows working knowledge of managed care and Medicare health plans and reimbursement related to post-acute services within the conti.

Read the full job description and apply online on the recuiter's web-site

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