Care Manager RN

Care Manager RN @ Swedish Edmonds

Full Time (40 Hour Week)

Day Shift 

8 Hour Shift 

$10,000 Hiring Bonus and relocation for eligible external candidates who meet all conditions for payment - this is in addition to the fantastic benefits and compensation package offered by Providence Swedish that begin on your first day of employment. Join us, and find out how many ways we offer you the chance to focus on what really matters - our patients.

Provides clinical case management functions via a collaborative process that transitions patients to optimal clinical outcomes while assuring safe, cost-effective care.  Demonstrates a daily commitment to the department's value of teamwork.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Swedish Edmonds and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Clinical Essential Functions:

 • Performs new admission assessments within designated time frames.

 • Facilitates/supplements the staff nurse role in reviewing, interpreting, integrating and analyzing patient clinical findings.  Communicates clinical findings and care recommendations effectively and collaboratively to achieve targeted outcomes.

 • Ensures consistent standard of care including the physician specific plan of care is followed for all patients.  Assures appropriate tests and treatments to the diagnosis are completed. Ensures referrals for medical consults are completed in a timely manner.  Identifies “Captain of the Ship” in complex cases with multiple practitioners.

 • Intervenes clinically, as appropriate, proposing alternatives to ensure a cost effective and efficient plan of care that meets clinical and regulatory standards. Provides supportive and therapeutic clinical interventions as indicated.

 • Evaluates and facilitates documentation 

Psychosocial Essential Functions:

 • Identifies risk factors and/or strengths of patient/family support system on admission and refers/communicates to appropriate team members.  Identifies abuse/neglect and refers appropriately for evaluation and reporting.

 • Assures ethical situations are identified and makes referrals to Medical Ethics Committee as indicated.

 • Ensures advance directives are in place and honored according to the patient’s wishes.

 • Identifies primary patient/family decision maker and communicates care plans as indicated.  Initiates and participates in patient/family conferences as needed.

Financial and Utilization Management Essential Functions:

 • Maintains knowledge of particular reimbursement methods and communicates reimbursement information to patients, families and the healthcare team.

 • Ensures patients are placed in the appropriate level of care according to the clinical situation and prescribed plan of care.  Screens for continued medical necessity and level of care. Assures approved days from payers.

 • Pre-screens for financial issues surrounding admissions and transfers.  Refers patients to financial counselor for information and to implement financial assistance forms.

 • Maintains awareness of payer contract requirements. Collaborates with managed care contracting staff on elements of plan performance and contract requirements. Conducts utilization review activities as required by managed care contracts.

 • Issues and explains extended stay denials.  Reviews impending denials with physician advisor.  Assists with information to support appeal of any business office denials.  Researches clinical denial claims and writes appeal letters.

 • Documents findings in patient medical record.  Monitors avoidable delays and days.

 • Maintains awareness of interqual guidelines and DRG length of stay standards. 

Transition (discharge) Planning Essential Functions:

 • Creates and implements transition plans for all patients collaboratively with SW Case Manager.

 • Participates in multidisciplinary transition planning meetings.

 • Makes referrals to “transition” facilities, assures the acquisition of DME and medications post discharge and directs transportation arrangements for discharge as needed.  Assists patient and family in accessing community resources.

 • Delegates functions to the Case Management Assistant as appropriate. 

 • Assures patient/family have sufficient education regarding condition, treatment and transition plans.

Performance Improvement Essential Functions:

 • Promotes health care outcomes in concert with currently accepted clinical practice guidelines and established clinical pathways.

 • Identifies p