Disease Management Case Manager jobs in Reno, NV

Bargaining Unit: Non Represented - Manager

Rate of Pay: $149,032 annually DOE

Summary
Ensures quality patient care is provided in a cost efficient manner, inclusive of tracking resource utilization and decreasing unnecessary hospital stays. The position is accountable for providing concurrent and retro reviews of the patient medical records using current guidelines. Responsible for overseeing daily operations/functions of Case Management Department.

Essential Duties and Responsibilities

• Screens all hospital admissions and review daily census
• Reviews and revises Case Management policies yearly
• Follows hospital -specific quality, safety and compliance standards
• Screens all hospital admissions against the high risk screening criteria for the need for discharge planning evaluation
• Knowledge of local community resources•
• Attends Utilization Management meetings per Centers for Medicare and Medicaid Services(CMS) requirements and completes the Utilization Management (UM) plan
• Attends all tier level huddles every morning and as needed
• Performs risk stratification, identifies and targets risk factors that underline multiple conditions that can lead to future high -cost patients or readmission/returns to hospital or emergency room
• Works adjunctively, when requested, with ECC personnel in the coordination of admissions
• Acts as a resource person in the area of case management.
• Has frequent contact with CNO, Director of Acute Care Nursing, Risk Manager and Revenue Cycle Director
• Promotes improvement in patient care through endorsement of quality assessment/improvement process.
• Performs ongoing nursing and medical staff case management education including appropriate levels of care.
• Develops operational budget recommendations for submission to the CNO
• Assures adequate staffing of Case Management in a safe and effective manner that uses resources appropriately.
• Covers unit as needed
• Responsible for time-care payroll adjustments, variance logs.
• Demonstrates System Values in performance and behavior.
• Complies with System policies and procedures.
• Other duties as may be assigned.

Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibilities
Carries out supervisory responsibility in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, training, assigning, coaching, counseling, and disciplining employees; administering scheduling systems; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; enforcing policies and procedures.

Minimum Education/Experience
Bachelor's Degree from college or vocational school from a National League of Nursing (NLN), Commission on Collegiate Nursing Education (CCNE) or equivalent accredited school of nursing. The nurse shall have completed a nursing education program that included clinical experiences with actual patients under the supervision of qualified faculty.

2-3 years relevant experience

Required Licenses/Certifications
California Registered Nurse (RN) - Upon hire

Nevada Registered Nurse (RN) - Upon hire

BLS: Employee will be enrolled in the Resuscitation Quality Improvement (RQI) Basic Life Support (BLS) Entry or Prep Curriculum (depending on their
previous BLS certification). - Within 3 months of hire into job

Other Experience/Qualifications

Required:

• Self-disciplined, energetic, passionate, and innovative.
• A team player that can follow a system and protocol to achieve a common goal.
• Highly organized and well-developed oral and written communication skills.
• Demonstrates sound judgment, decision-making and problem-solving skills.
• Able to maintain confidentiality with all aspects of information in accordance with practice, State and Federal regulations.
• Confidence to communicate and outreach to other community health care organizations and is aware of community resources.