RN Case Manager - Days

• INTEGRIS is an Equal Opportunity/Affirmative Action Employer. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

• Completes a comprehensive assessment of patients clinical, psychological and financial needs utilizing all available resources.
• Recommends and coordinates timely transfers to appropriate levels of care as indicated by clinical needs and utilization criteria.
• Develops, implements, evaluates and revises, as necessary, a plan for discharge, including referrals to other health care and community organizations based on needs assessment.
• Communicates discharge care plan, and any changes in the plan to patient, family and all appropriate healthcare professionals.
• Assists physicians and hospital staff in appropriate utilization of resources through application of utilization criteria and facilitating timely discharge planning for patients.
• Coordinates services between hospital departments to facilitate timely patient discharge.
• Conducts concurrent review of patient records on admission to the hospital and as determined by the patient's clinical condition.
• Applies utilization criteria accurately in order to determine appropriate utilization of resources.
• Notifies designated internal and external contacts of utilization issues that may affect patient care and/or reimbursement.
• Facilitates patient transfers to other health care organizations in accordance with hospital policies and all-applicable state and federal guidelines and regulations.
• Acts as a resource/advisor to physicians regarding discharge planning, medical record documentation, and all issues that may affect resource utilization and reimbursement.
• Integrates and manages established pathways, where available, to enhance clinical effectiveness and clinical resource management.
• Maintains knowledge and understanding of CMS regulations, Medicare/Medicaid, managed care and other payer regulations and benefit limits.
• Acts as a resource and provides education for patients, their family members and all health care professionals regarding HCFA regulations, Medicare, Medicaid, managed care and other payers.
• Develops and maintains knowledge and understanding of hospital and community resources, and facilitates use of most appropriate level of care to conserve patient, hospital, and payer resources.
• Identifies opportunities to reduce cost of managing patient care without impacting quality or outcomes.
• Participates in collecting and recording data for utilization and Quality Improvement reporting. * Works collaboratively and professionally with patients, family members, and physicians, hospital staff and other individuals and agencies involved in providing patient care.

• Leads age and developmentally appropriate patient education and recreational groups to address the emotional, physical and environmental needs of Mental Health and/or Chemically Dependent patients.
• Provides documentation daily in patients' charts on each group facilitated. Facilitates discharge planning to assist patients in placement and treatment following discharge.
• Participates in the development of patient plans of care to address goals of the patient (emotional, physical, spiritual, environmental) by attending treatment team meetings.
• Participates in the writing of treatment plans with other program staff and physicians on hospital approved form.
• Assists in utilization review process by contacting patients' insurance companies to provide clinical information to authorize patient treatment.
• Serves as a patient advocate in the patients' needs, as well as those individuals involved with patients (as relevant).
• Assists in the development and execution of marketing the program services to appropriate entities (outpatient therapists, primary care physicians, inpatient programs, etc.).
• Completes or facilitates the completion of Emergency Detention paperwork, as well as ensure its distribution and receipt by legally designated individuals.
• Provides physician ordered therapy in the areas of individual, family and marital sessions.
• Develops and facilitates age and developmentally appropriate patient psychotherapeutic groups.
• Is responsible for reviewing and noting physician orders.
• Monitors patients' medications and provide education related to use and side effects.
• Monitors vital signs as indicated by physician orders or if deemed medically necessary.
• Assesses patients for appropriateness of admission to the program.

• Documents and communicates in a timely fashion patients progression throughout the continuum of care to all necessary parties via electronic, written, and verbal means.
• Apprises team members of challenges encountered throughout the continuum of care via electronic, written, and verbal means.
• Utilizing strong organizational skills, personally manage evolving calendar of commitments in the best interest of the patient and organization.
• Utilizing excellent interpersonal, collaborative, and conflict resolution skills, act in the capacity of liaison between the patient, medical provider, and the organization to achieve positive outcome.

• Leads age and developmentally appropriate patient education groups to address the emotional, physical and environmental needs of Behavioral Health and/or Addiction Recovery patients.
• Participates in the writing of treatment plans with other program staff and physicians.
• Assist in utilization review process by contacting patients? insurance companies to provide clinical information to authorize patient treatment.
• Serves as a patient advocate in the patients' needs, as well as those individuals involved with patient.
• Completes or facilitates the completion of Emergency detention paperwork, as well as ensure its distribution and receipt by legally designated individuals.
• Processes orders/refills or laboratory for ordering physician.
• Monitors patient's medications and provide education related to use and side effects.
• Monitors vital signs as indicated by physician orders or if deemed medically necessary.
• Provides referrals options for patient's who are assessed, but do not enter the program.
• Completes a comprehensive Initial Mental Health Assessment of patients clinical, psychological and financial needs utilizing all available resources.
• Attends and participates in treatment team.

• 5 years experience in a variety of clinical settings (e,g. home health, inpatient, physician office, clinic) required.
• Experience with managed care and payer/provider requirements preferred.
• Current licensure as a Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state.
• BSN preferred.
• Excellent interpersonal communication and collaboration skills.
• Computer experience required. Windows preferred.
• Current Case Management Certification preferred, at minimum attained within one year of hire (INTEGRIS Certified Case Management only)
• Current Driver's License issued by the state of Oklahoma.

Integris Health