The Case Manager will work with nursing and rehab services to provide patient care coordination and discharge planning for inpatient and Transitional Care (Swing Bed) admissions. The Case Manager will be knowledgeable of utilization review requirements to assist medical and nursing staff with compliance to Medicare and Medicaid Conditions of Participation. The Case Manager coordinates patient care from pre-admission through discharge, and is actively involved in program and quality measures.
The Case Manager works with members of the healthcare team to assure a collaborative approach is maintained in care and treatment of the patient. The Case Manager maintains performance improvement activities for the Transitional Care Unit, discharge planning, and reports activities to the performance improvement committee of the hospital.
Essential Functions & Responsibilities
- Promotes the mission, vision and values of the BMHD.
- Knowledgeable about Transitional Care in a critical access hospital and CMS guidelines regarding those services.
- Monitors the program quality measures and supports the development of action plans as needed to improve program processes and outcomes.
- Participates in marketing and referral development activities
- Identifies and develops new product lines to meet the needs of the community served.
- Develops strong relationships with the other acute care hospital discharge planning staff within the referral area.
- Is recognized by the care team, administration, patients and families as an essential leader.
- Assess appropriateness of all referrals, engages and educates patient and family on expected discharge plan.
- Ensures the Transitional Care program components are in place and functioning properly.
- Communicates with family member and caretakers regarding the needs of the patient and anticipated plans including community resources. Discharge planning goals are established in coordination with the patient and family/caretaker.
- Acts as the patient’s advocate for financial assistance or other needs.
- Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed.
- Follows through on patient referrals to or from other facilities.
- Accurately determines type of assistance/setting/resources necessary for the patient/family and arranges for appropriate resources/assistance/list of facilities.
- Coordinates with third party payers on a regular basis.
- Understands the utilization review process to ensure patients are admitted appropriately.
- Writes or updates utilization review policies as needed.
Knowledge, Skills & Abilities
- Maintains self-motivation and sustains a high level of momentum.
- Able to successfully prioritize when faced with requests, demands and deadlines.
- Knowledge of customer service concepts.
- Must be detail oriented and able to perform accurate and thorough recordkeeping.
- Proven ability to communicate effectively, both in written and oral form.
- Ability to communicate effectively in English, both verbally and in writing.
- Proven ability to work as part of a team, in a fast-paced production-oriented environment.
- Proven presentation skills.
- Expresses excellent judgment, discretion and decision making abilities.
- Supports and maintains a culture of safety, quality and positive patient experience.
- Working knowledge of relevant regulatory requirements, CMS, National Patient Safety Goals (NPSGs), and continued readiness related to healthcare or hospital standards.
- Ability to prioritize, highly organized.
Education, Experience & Certification/Licensure
- Graduate of an ac
- RN License, in good standing with State of Oregon.
- 3-5 years of clinical expereince in a hospital
- Case Managment experience, knowledge of utilization review
- Basic Life Support (BLS) certified by American Heart Association (AHA)
- Bachelor of Science in Nursing Degree (BSN)
For More Information, Contact
Holly Thompson, Human Resources
firstname.lastname@example.org | 541-575-3820
Why Blue Mountain Hospital District & Grant County?
The Blue Mountain Hospital District (BMHD) is located in Grant County, Oregon, at the heart of the John Day River, in beautiful, rural, Eastern Oregon. Our District is comprised of a Critical Access Hospital (CAH), Family & Rural Medicine Clinic, Home Health and Hospice, Emergency Medical Services, an Intermediate Care Center and all of the supporting ancillary departments necessary to care for the health and wellness of our community.
Our District spans from John Day to Prairie City, nestled in a valley surrounded by the Blue Mountains. The Strawberry Mountain Range and John Day River Valley offers a variety of outdoor activities, from abundant hiking/mountain biking/horse riding trails, to high and low lakes and ponds. Our area is known to be a “go to” place not just for recreation, but also for big game hunting and fishing!
Join our family-like team and settle into a lifestyle that is hard to beat!