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Everyone who works with Mercy Health is united under one purpose: to help our patients be well in mind, body and spirit. This drive, along with our history of faith, is a powerful combination. It gives us a shared calling to work toward every day. Join our exceptional team and help us continue to provide the highest quality of health care possible to our communities.
Primary Function/General Purpose of Position
The RN Case Manager coordinates the care and services of selected patient populations across the continuum of illness; promotes effective utilization and monitoring of health care resources; and leadership role with the interdisciplinary team to achieve optimal clinical, resource and quality outcomes.
Essential Job Functions
Accurately identifies patients who meet the guidelines for case management. Develops, implements, monitors and modifies the plan of care for the patient through a collaborative and interdisciplinary team process. Assesses the patient’s physical, psychological, functional, social, environmental, and financial status and goals. Utilizes the data collected in the assessment process to formulate and document interdisciplinary outcomes (goals) to be achieved. Continually assess outcomes and goals for workability, manageability, cost effectiveness, and updates the plan as needed. Maintains patient confidentiality and is knowledgeable of the HIPAA guidelines for patient confidentiality. Actively participates in Quality flow rounds. Assists direct care staff in establishing daily goals and monitors the progress in meeting these goals.
Locates community resources and links the patient to the most appropriate ones. Evaluates the patients’ s formal and informal support systems. Assesses family/caregiver coping styles, and the ability of the family/caregiver to support and participate in the planning of care. Acts as a leader and a liaison among the disciplines. Facilitates communication with all providers of care, and facilitates access to care. Assumes responsibility for cost effectiveness.
Analyze information required to make clinical and business decisions. Translate data into meaningful information.
Evaluates professional activities to assure that the planned services are being delivered and that they meet the stated outcomes/goals. Monitors the patient’s progress towards outcomes and makes recommendations as to the continuation of services. Is knowledgeable of disease processes, treatment protocols, and pharmacological management to assure appropriate care delivery.
Understands payer principles, terminology of managed care, and the goals of the managed care Industry. Assures that the hospital is able to provide the necessary care needed to meet the physical/medical needs of the patient. Maintains knowledge of community services and agencies. Advocates for the patient and/or hospital as appropriate when dealing with insurance companies/third party payers.
Is knowledgeable of Length of Stay and Case Mix Index and ways of improving. Is accurate, consistent and concurrent in documenting insurance and other data elements in the appropriate case management computer tools. Understands the knowledge and principles of the hospital DRG assurance program.
Demonstrates technical proficiency and seen as an expert within assigned clinical and business function.
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
Qualifications
Required Minimum Education:
Associates Degree
Specialty/Major: Nursing
Preferred Education:
Bachelor of Science in Nursing (BSN) or Graduate Degree (Masters)
Specialty/Major: Nursing, Healthcare
Licensure/Certification:
RN License in the state of work (OH) (required)
Case Management Certification (ACM, CCM, or ANCC) (preferred)
Minimum Years and Type of Experience:
5 years experience as an RN in a hospital and/or clinic setting; basic CPR
Other Knowledge, Skills and Abilities Required:
EPIC Electronic Medical Record; Board fairly detailed knowledge of InterQual and MCG criteria.
Many of our opportunities reward* your hard work with:
Comprehensive, affordable medical, dental and vision plans
Prescription drug coverage
Flexible spending accounts
Life insurance w/AD&D
Employer contributions to retirement savings plan when eligible
Paid time off
Educational Assistance
And much more
*Benefits offerings vary according to employment status
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email (url removed). If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at (url removed)
