20,000 SIGN ON BONUS AND RELOCATION ELIGIBILITY

Facility

Cape Fear Valley Medical Center

Location

Fayetteville, North Carolina

Department

Coordination of Care

Job Family

Nursing

Work Shift

Days (United States of America)

Summary

The ED RN Case Manager is responsible for performing the initial Utilization Review determination on patients admitted or placed on observation status from the ED setting during defined hours of work. Direct discussion with the ED physicians as well as admitting hospitalist and private physicians is conducted to determine medical necessity for admission. Partners with physicians to establish appropriate status and level of care requirements. Reviews direct admissions and planned surgeries for appropriate status orders. Maintains compliance with regulation changes affecting utilization management. Performs utilization review in accordance with all state mandated regulations. Works with physicians, ED SW Case Manager, and interdisciplinary team to facilitate clinical guidelines and achievement of desired treatment outcomes. Promotes interdisciplinary collaboration and champions service excellence. Works collaboratively to ensure patient needs are met and care delivery is coordinated across the continuum at the appropriate level of care. Collaborates with the ED physician and Hospitalist staff to avoid unnecessary admissions to the hospital. Performs readmission assessments on patients who are admitted with a 30-day readmission status to identify proactive plan to prevent further reoccurring admissions. Performs discharge planning assessments on patient's identified with barriers to transition to next level of care.Profession Certification in Case Management (CCM or ACM) preferred. Minimum three to five years’ experience in Acute Care setting preferred. Medical/Surgical and/or ICU experience preferred. Case Management Experience preferred. Additional one year in managed care claims/reimbursement or other healthcare field preferred. Strong clinical background. Knowledge of professional nursing principles, clinical processes and clinical interventions. Excellent interpersonal communication and negotiation skills. Able to communicate effectively and work with people of all social, economic, and cultural background. Self-motivated, proven written, telephonic and electronic communication skills, assertive and persuasive in interactions with customers, peers, management and core staff served. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components. Understanding of criteria and measurement outcomes. Knowledge of third party payor requirements including managed care, reimbursement and utilization management. Proficiency with various computer programs, to include Microsoft Office, Midas, Allscripts, ValleyLink, eHIM, Teletracking, EMSTAT and SMS. Skills necessary to build credible and effective relationships with physician leadership, the internal and external customer. Flexible, open-minded and adaptable to change. Models positive change. Ability to demonstrate respect and team building. Able to prioritize and process multiple tasks, responsibilities and work projects, demonstrating strong organizational and time management skills. Demonstrated ability to analyze related information, plan effective actions and follow through reliably to meet expectations. Ability to work and promote interdependence demonstrated in actions resulting in sound judgment with interactions with physicians, peers, patients and /or designee, payors, support service personnel. Ability to work collaboratively with department staff, physicians and healthcare professionals at all levels to achieve established goals, improve quality of outcomes, maintain or exceed Joint Commission standards and state mandates as they apply to the department operations.Some light carrying and lifting may be required. Occasional walking may be required to access all areas of the Medical Center. Ability to effectively communicate orally to patients, family members, personnel and physicians. Near visual acuity to proofread hand or typewritten materials. Manual ability to use telephones and computer keyboard. Position involves sitting for extended periods of time performing data entry into a computer.

Required Licenses and Certifications

RN - Board Of Nursing

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity