RN Care Manager - Inpatient

Essential Job Functions

Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations.

Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.

Conducts initial and ongoing assessments and chart reviews of each assigned patient to identify potential and or actual barriers and care needs.

Proactively screens and assesses the acuity and transitional needs of each assigned patient.

Engages and collaborates with patients, support systems and the multidisciplinary / healthcare team to establish a plan of care that addresses the mutually identified needs of the patient.

• Interventions and Care Coordination
• Demonstrates the ability to interpret clinical information and understand health care treatment and systems.
• Supports patients to ensure they can function to the best of their ability and maintain optimal health related to their medical condition(s).

Identifies and addresses gaps in knowledge / understanding / education related to disease management.

Participates in the patient’s plan of care by interacting / collaborating with patients, support systems, healthcare professionals and community and state agencies.

Serves as a liaison between hospital, clinic and community agencies to facilitate the exchange of clinical and referral information.

• Identifies high-risk patients through risk stratification tools and ongoing assessments including ED utilization and hospitalizations to address the medical / psychosocial / financial needs of patients and their support systems in both hospital and ambulatory settings.
• Reinforces goals of care and treatment plans with patients and support systems in order to enhance patient and support system engagement.
• Coordinates care conferences to support effective communication as needed.
• Helps navigate the patient throughout the continuum of care.
• Effectively collaborates and coordinates care with the Social Services Care Manager.
• Maintains current knowledge of community resources and ancillary clinical services to meet the needs of hospital, clinic and regional customers.
• Provides information about available resources to patients and their support systems.
• Partners with the multidisciplinary / healthcare team and the Social Services Care Manager to guide / advocate placement to the appropriate Acute rehab, LTACH, SNF, long-term care facility, assisted living facility, or Home Health Care, in-home services, hospice, ancillary OP services and / or DME as clinically appropriate.
• Acts as a clinical resource to the Social Services Care Manager.
• Understands consultative disciplines and their role in patient care.
• Maintains respectful and professional communication skills.
• Insurance and Utilization Management
• Maintains working knowledge of CMS requirements and readmission penalties.
• Maintains working knowledge of insurance / payer benefits.
• Evaluation
• Monitors the need for revisions in the plan of care and makes recommendations to the multidisciplinary / healthcare team when indicated.

Modifies the plan of care / goals to reflect changes in patient or their support system status and needs.

• Monitors, evaluates and documents patient progress related to plan of care.
• Documentation
• Documents accurately and in a timely manner in the Electronic Medical Record per program guidelines.
• Utilizes standards of professional practice in all documentation and communication consistent with organization / department policy as well as the Board of Nursing and ethical guidelines established and universally supported by the nursing profession.
• Documentation and patient information shall be secured and maintained in accordance with Billings Clinic policy, HIPPA, state and federal guidelines.
• Safety / Quality Assurance / Risk Management
• Identifies service gaps and participates in hospital and department programs to address and improve quality of care.
• Advocates for marginalized or vulnerable populations by identifying cases of abuse and neglect and appropriately involving risk management and regulatory agencies.
• Professional Accountabilities
• Participates in continuing education, department planning, work teams and process improvement activities.
• Maintains current Licensure.
• Adheres to department and organizational policies addressing confidentiality, infection control, patient rights, medical ethics, advance directives, disaster protocols and safety.
• Demonstrates the ability to be flexible, open minded and adaptable to change.
• Maintains competency in organizational and departmental policies / processes relevant to job performance.
• Utilizes standards of professional practice in all communication with patients, support systems and colleagues consistent with the Board of Nursing and ethical guidelines established and universally supported by the nursing profession.
• Performs all other duties as assigned or as needed to meet the needs of the department / organization.
• Inpatient Care Management Specific
• Collaborates with post-acute services, Ambulatory Care Managers and PCP’s to ensure successful transition back to the home environment.

Makes appropriate Ambulatory Care Management referrals. Anticipates those patients who may require more support after hospital discharge and communicates these concerns.

• Utilizes length of hospital stay, past utilization of resources and risk stratification to identify patients at high risk for readmission.
• Interfaces effectively with the Utilization Review department to stay current on patient’s eligibility for admission, continuing stay, or readiness for discharge.
• Communicates with medical staff, coordination team and nursing staff regarding appropriateness of admission, need for continued stay and discharge plans.
• Identifies and records episodes of avoidable days.
• Evaluates the appropriateness of care delivery in the inpatient setting and communicates any discrepancies with the medical team.
• In addition to the above Care Managers in the Emergency Department will also be responsible for the following duties :
• Screens ED admissions using established criteria for specific payer populations
• Understands insurance / payer policy language, benefits and authorization requirements for admission
• Discuss payor criteria and issues on a case-by-case basis with clinical staff

Ensures that the patient is in the appropriate status and level of care for the clinical condition. Utilizing screening criteria and physician advisor, per department standards

• Outpatient Care Management Specific
• Receives referrals on patients being seen in the clinic (Primary Care, SDC, specialty office, ancillary departments). Coordinates services for medical and non-medical care coordination needs that are episodic or longitudinal.
• Receives referrals for elective procedure patients who would benefit from pre-discharge planning assessments and resource coordination.
• Assists patients through care transitions from hospital to home, SNF to home / assisted living, or alternate setting per program guidelines.
• Manages a panel of high-risk patients that require longitudinal education and support.
• Effectively collaborates with Inpatient Care Managers and Social Service Care Managers to address the needs of shared patients.
• Able to function effectively as a part of a team. Utilizing shared knowledge to address complex patient needs.
• Supports Billings Clinic and community-based programs to advance the role of Outpatient Care Management, strengthen partnerships and meet department and patient needs.

Minimum Qualifications

Education

4 Year Bachelor of Science in Nursing (BSN) or Bachelor of Arts in Nursing (BAN) preferred

Experience

Five (5) years of professional nursing (one within the Billings Clinic) in a related cardiac care area such as critical care, ambulatory telemetry unit, or emergency services

Certifications and Licenses

• Healthcare Provider and ACLS CPR certifications
• National Institutes of Health Stroke Scale (NIHSS) certification required or to be obtained within first year of employment Within 1 year of hire
• Current Registered Nurse license in the state of Montana

Employee Benefits

Billings Clinic Employees

Billings Clinic is a best place to work because if its people. The collegial atmosphere, teamwork, pride in care, and numerous opportunities to grow both personally and professionally help keep our amazing employees here caring for patients.

State of the art facilities and advanced technology gives the health care professionals the tools to provide advanced health care in a healing environment.

• 2019 Billings Chamber of Commerce Employer of the Year
• 2019 Becker’s 50 Best U.S. Companies to work For
• 2019 Women’s Choice Award for America’s Best Hospitals for Patient Experience
• LivAbility One of the Top 25 Best Places to Live in America
• 2016 Outside Magazine’s America’s Best Town

Employees have the opportunity to make a difference in the lives of each other and our patients, making this a truly meaningful place to work.

The organization also offers employees the opportunity to engage in numerous councils and educational opportunities leading to career growth and involvement in decision making and important initiatives.

Beyond giving great care, employees’ ideas and insights are valued at every level of the organization.

At Billings Clinic, it is important to celebrate milestones and ensure that employees feel valued. Recognitions such as the DAISY or BEE Awards, Years of Service and the employee recognition program give everyone the opportunity to show encouragement toward team members who go the extra mile.

Billings Clinic offers excellent benefits and salaries, education assistance, paid time off, and learning plans for career growth.

The combination of excellent benefits, strength of the organization and meaningful work make Billings Clinic one of the best places to spend a career in health care.

Billings, Montana is a friendly college community located near the magnificent Rocky Mountains with great exciting outdoor recreation just minutes from home.

Billings has great parks, trails, public lands, thriving restaurants, excellent schools, safe neighborhoods, and abundant events and family activities.

Explore some of the Billings Clinic employee benefits

Health

BeWell -An employee wellness program with initiatives and resources around Health, Finance, Personal Growth, and Community.

Programs include free blood screenings, flu shots, biometric screenings, health assessment, incentives such as insurance premium discounts for participation.

Medical -Billings Clinic offers a comprehensive self-insured health plan, including a traditional PPO plan and an HSA plan.

The benefit is available to full or part time employees.

• Pharmacy- Our medical plan includes prescription benefit coverage and prescriptions can be filled at the Atrium Pharmacy on our campus with a mailing service available to employees who reside outside of Billings.
• Dental- Preventive and Comprehensive plans include preventive and major dental services such as fillings, extractions, bridgework, dentures and crowns.
• Vision- A vision plan is available; which covers a routine eye exam and provides an allowance for the purchase of frames, lenses or contact lenses.
• Flexible Spending Accounts- We offer two types of spending accounts : health care and dependent care. Both allow you to pay certain expenses with pre-tax dollars.
• HSA Savings Accounts- We offer an HSA savings accounts and an employer contribution for full time employees.

Short Term Disability / Medical Leave -Billings Clinic provides a short term disability medical plan which provides employees with days to use in the event of an extended illness or injury.

Financial

• Paid Time Off -Billings Clinic recognizes an employee's need to balance work and family life. Billings Clinic provides a paid time off benefit which affords employees the opportunity to have time off with pay.
• Retirement Plans -Billings Clinic provides a defined contribution pension plan and a 403(b) tax deferred savings plan with matching contributions.

These plans offer employees the opportunity to save for their retirement years with a variety of investment options available.

• Flexible Spending Accounts- We offer two types of spending accounts : health care and dependent care. Both allow you to pay certain expenses with pre-tax dollars.
• HSA Savings Accounts- We offer an HSA savings accounts and an employer contribution for full time employees.

Tuition reimbursement and / or assistance programs are available for certain positions.

Employee Crisis Fund -Provides limited financial assistance to Billings Clinic employees who need immediate aid.

Growth & Community

• Employee Assistance Program (EAP)- Billings Clinic recognizes that mental well-being is connected to physical health. We offer employees and their eligible dependents, at no cost, four sessions of mental health related services through our confidential EAP program.
• Billings Clinic Parent Network (BCPN) -A unique group to support the employees who also wear the hat of parent . The group meets monthly to discuss the challenges of being a working parent and provides encouragement and support.
• Cafeteria and Commons Café- meal subsidies
• Bicycle-friendly business- Bronze award winner by the League of American Bicyclists
• Tuition reimbursement and / or assistance programs are available for certain positions.
• Leadership training
• Employee recognition programs such as the Bee Award for outstanding team members, Daisy Award for nursing excellence, Great-Catch Award (safety), Years of Service award, YAG awards.

Several employee recognition events throughout the year such as the food truck outdoor event, hot cocoa bar event, etc. to promote fun and employee recognition.

• Free or discounted tickets to local entertainment and sporting events
• Club Billings Clinic offers employees discounts at numerous local businesses and service providers
• Lactation facilities for new mothers.
• 360-degree performance reviews
• Our organization promotes sustainable or green practices.
• Identity Theft Protection and Emergency Travel Assistance
• Business education, continuing education credit assistance
• Formal career development and job advancement programs
• Actively supports community service initiatives, e.g. United Day of Caring, Saturday Live, etc.
• Flexible scheduling and telecommuting options for certain positions to accommodate work / life balance

Casual Fridays"-ability to wear work appropriate jeans to work (for non-clinical employees)

• Workplace facilities to promote exercise
• Promotes walking trails both inside and around the campus
30+ days ago