RN Case Manager

Department Overview

The Care Management department provides several major services to assure safe and efficient through-put of patients during their acute hospitalization and transition to the next level of care. Our goal is to balance individual clinical and psychosocial patient / family needs with the efficient and cost-effective utilization of resources while promoting quality outcomes.

RN case managers assess patients on admission for available family support, insurance resources, and potential discharge planning needs. They engage in daily multidisciplinary rounds Monday through Friday to develop and implement patient discharge plans with input from various other disciplines. The RN case manager is responsible for coordinating post-acute and discharge needs in a timely and cost-efficient manner. Using established criteria to determine appropriateness of continued hospital stay, RN case managers work with payors on obtaining needed authorizations for ongoing hospitalization and / or identified post-acute needs.

The RN Case Manager collaborates with the patient and family, members of the multidisciplinary team, community resources and agencies, and payors to ensure the patient's progress and level of care is appropriately determined. Intensity of service is dependent on individual patient needs as assessed by the case manager. RN case managers practice robust utilization and resource management.

RN case managers also frequently lead multidisciplinary and family care conferences involving complex care situations. They contribute to meeting OHSU's strategic plan of safe length of stay reduction and reduction in readmission rates.

Case Management is represented on every adult and pediatric unit and in the Emergency department. Each Case Manager has an office with a workstation near the unit they are assigned to. Communication factors : Case Managers are available by pagers, telephone / voicemail, Microsoft Teams, Epic Secure Chat, and e-mail.

Function / Duties of Position

Case Management is represented on every adult and pediatric unit and the Emergency department.

Communication factors : Case Managers are available 7 days a week between the hours of 0700-2300. They are available by pager, telephone, e-mail, and approved messaging applications.

Admit / ED Nurse Case Manager : In addition to the above basic CM functions, also provides the following -

• Assuring accurate patient status and admission order for pts entering via ED, and OR, 7 days per week
• Reviews ED Observation unit patients for meeting observation criteria and completes UR using established criteria.
• Round with NP in ED OBs by 10am.
• Effectively communicates reviews with Patient Placement Office.
• Follows up in collaboration with unit CM on admission status and completeness of Utilization review on admission.
• Performs discharge planning for patients in the Emergency department
• Assesses patients potential to DC from ED with community care coordination (PCP location, follow up appointments, medication assistance, SNF, long term care, DME, Memory or Foster care)
• Back up for weekend / EVE Case Managers.
• Follows current data tracking procedures
• Reviews transfer center patients and advise physicians on acceptance of potential transfers.
• Preforms Utilization Review for each patient admitted without a review during weekend hours using established medical necessity guidelines.
• Reviews order / classification discrepancies and take actions to resolve the discrepancy.
• Discusses cases with providers and Case Managers as needed, including attending physicians and escalation to the Care Management Physician Advisor when indicated.
• Assesses for and tracks potentially avoidable hospital days.
• Educates providers regarding documentation requirements that support medical necessity determinations.
• Delivers Condition Code 44 notices, Observation notices, and Medicare Important Messages in the absence of sufficient clerical support.
• Documents according to departmental policy.
• Leads the effort to assure compliance with CMS and other insurance regulations related to Utilization Review.

Evening Shift RN Case Manager

RN Case Managers are responsible to be aware of and comply with regulatory requirements of DNV, Medicaid, Medicare and Oregon Nurse Practice Act.

Department Specific Working Conditions :

Case Management is represented on every unit and the Emergency department.

The Care Management central resource office is located in 9A4.

Each Case Manager has an office with a work station near the unit they are assigned to.

Communication factors : Case Managers are available by pagers 7 days a week during the day. They are also available by telephone / voicemail and e-mail.

Required Qualifications

Department Specific Requirements (competencies, equipment, certifications, etc.) :

Ability to describe what utilization review criteria is and how it is utilized.

Preferred Qualifications

Additional Details

This position also comes with great benefits! Some highlights include :

All are welcome

Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or aaeo@ohsu.edu.