RN Case Manager - Care Coordination
Company: Swedish Health Services
Posted on: May 3, 2021
Swedish Medical Center is looking for a RN Case Manager (1.0
FTE, Day Shift) to work for the Care Coordination Department at
Swedish Edmonds in Edmonds, WA.
The RN Case Manager is responsible for 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
In this position you will:
- Clinical Essential Functions:
- Performs new admission assessments within designated time
- 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
- 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
Required qualifications for this position include:
Preferred qualifications for this position include:
- Hospital-based case management experience
About the Edmonds Campus:
Swedish/Edmonds (formerly Stevens Hospital) has been providing
sound and thoughtful care for patients in the greater Seattle area
for more than 45 years. We pride ourselves in employing only the
most qualified and caring professionals. We are not simply a
hospital or a workplace. We are a family. We are a community. Our
mission is to improve the health and well-being of the community
through local, high-quality and compassionate health care services.
On Sept. 1, 2010, Stevens joined the Swedish family and became
Swedish/Edmonds to create an innovative, regional health-care
delivery network that provides more local services, while giving
residents greater access to the latest medical treatments and the
comprehensive services of the Swedish system.
The Swedish/Edmonds campus includes:
- 217 licensed beds
- 450 of the most qualified physicians and specialists on medical
- 1,400 staff including clinical and non-clinical personnel
- Full scope of medical and surgical services, including Level IV
Trauma emergency medicine, diagnostic, treatment and support
Keywords: Swedish Health Services, Edmonds , RN Case Manager - Care Coordination, Other , Edmonds, Washington
Didn't find what you're looking for? Search again!