Jobs for People with MS: National MS Society

At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence.

Primary Function/General Purpose of Position

The RN Care Manager is a key contributor to the overall financial, quality, and clinical performance at St. Francis Health System. The RN Care Manager will:

• Facilitate the extraction of all clinical documentation necessary to qualify a patient for hospital level of care utilizing the information maintained in the electronic medical record (ConnectCare®).

• Provide a positive financial impact to the institution through interaction with physicians, nursing staff, other patient care givers, and coding professionals to ensure that medical record documentation accurately reflects the level of services rendered to patients and the clinical information utilized in profiling and reporting outcomes is complete.

• Monitor and evaluate care to ensure costs are medically necessary, provided in the most appropriate setting, and are generated according to governmental and regulatory agency standards.

• Identification and reporting of potential quality of care issues and reporting of variances through the Quality Improvement Program. Educate all members of the patient care team on documentation guidelines on an ongoing basis. Responsible for the timely coordination of health care services for selected patient populations to meet specific health care needs in a cost-effective manner. Support an outcomes-oriented patient care delivery system, which places the patient at the center of all activities.

Coordinate patient education to promote independence and the ability to care for one’s self.

• Serve as the primary clinical resource to assist the social worker in developing, altering and expanding the discharge plan of care on high-risk patients to encompass multidisciplinary patient care needs.

Employment Qualifications

Education:

• Graduate of an NLN accredited school of nursing.

• Bachelor of Science degree in Nursing (BSN) or currently enrolled in a BSN program.

• Current, unrestricted license to practice nursing in the State of South Carolina.

• Five (5) years of recent acute care nursing or four (4) years recent clinical experience, and one year utilization review experience.

• High level of clinical skills required.

• Utilization management experience preferred.

• Familiar with Medicare MS-DRGs and Medicare PPS preferred.

• Performance Improvement (PI) experience preferred.

• Clinical leadership experience preferred.

• Milliman medical review criteria experience preferred.

• Knowledge of acute care regulatory/accreditation requirements preferred.

• Excellent computers skills and current knowledge of the electronic medical record.

• Certified Care Manager (CCM) certification preferred

Essential Job Functions

Utilize proactive triggers (diagnoses, cost criteria, and complications) to identify potential over/underutilization of services gleaned from all information maintained in the electronic medical record (ConnectCare®). Facilitate transfers/discharges to lower acuity units or settings as appropriate. Demonstrate knowledge of documentation requirements and guidelines in accordance with Medicare and other Regulatory Agencies. Identify the most appropriate principle diagnosis and complications and co-morbid conditions (CC’s) including data to accurately reflect severity of illness in compliance with regulatory agencies. Confer with Clinical Documentation staff face to face or via a question sheet to clarify information, obtain needed documentation to establish severity of illness and intensity of service. Conduct follow-up reviews of medical necessity and update documentation at least every two to three (2-3) business days. All Medicare, Medicaid and indigent Observation patients are reviewed daily and sent to second level review by Physician Adviser. Review clinical issues with the Physician to establish medical necessity for all patients. Participate in ongoing education for staff, including new clinical documentation practices, and the electronic medical record (ConnectCare®). Initiate and upgrade initial clinical review to reflect any changes in the patient status, procedures/treatments, and confer with the physician to identify primary diagnosis. Evaluate Medicare admissions for appropriateness using approved criteria to determine Severity of Illness (SI) and Intensity of Service (IS) and confer with physicians for inappropriate cases or cases that do not meet the approved criteria. Refer all Medicare, Medicaid and Self-pay patients to Physician Adviser for second level review when inpatient status is questionable. Refer all Medicare, Medicaid and Self-pay Observations patients to Physician Adviser daily. Include Quality Assurance in every aspect of Care Management role. Monitor and evaluate the quality of care provided concurrently. Report variances through the Quality Improvement Program. Improve the overall quality and completeness of clinical documentation by performing admission/continued stay review using clinical documentation guidelines. Implement appropriate referrals to Physician Advisor in a timely manner. Prioritize patient care needs based on situational analysis, functional assessment, medical record review, and application of clinical review criteria. Act as the primary clinical resource to assist the social worker in developing and expanding the plan of care to encompass multi-disciplinary patient care needs. Facilitate multi-disciplinary patient care by maintaining rapport and communication with the treatment team to monitor and evaluate the plan of care, identify/prioritize problems and make adjustments made as required. Collaborate with Social Worker, hospital staff and medical staff to direct care towards predictable and fiscally responsible outcomes Maintain relationships and open communication with the patient/family to provide concurrent information regarding diagnostic testing, treatment plans and outcomes. Participate in the development, implementation and evaluation of clinical pathways. Provide/initiate appropriate education to the patient/family and develop new educational resources if gaps exist. Educate hospital and medical staff regarding Care Management, Utilization Review and other current related issues toward the reduction of length-of-stay. Educate internal staff on and changes in clinical documentation expectations or medical necessity/patient status issues. Maintain positive, open communication with physicians, interdisciplinary care team members and department managers and attend all interdisciplinary care rounds on assigned unit(s). Assist the Social Worker where necessary with discharge planning activities all discharge planning notes from are documented in (ConnectCare®) through case management one stop. Utilize Ensocare CareFinder Pro when making referrals to the next level of care when patient is not discharging to home. All care management staff (RN/SW) will be responsible for the following: Initiates and explains Condition Code 44 after discussion with attending physician and virtual UR nurse. Initiates and explains Observation letters on admission and obtains signature for all patients within 24 hours of admission. Initiates and explains Medicare/Medicaid in house denial after collaboration with attending Physician, Care Management and/or Administrator.

Skills: Must possess the ability to:

• Organize information quickly and effectively.

• Prioritize and complete multiple tasks effectively.

• Participate in the team as an equal, active member.

• Remain oriented to customer service at all times.

• Document completely and accurately in the medical record and in other written forms of communication.

• Communicate ideas and thoughts efficiently verbally and in written form.

• Think critically and formulate ideas easily.

• Adapt to an ever-changing environment.

• Remain flexible in various situations and problems.

• Evaluate, assess, and teach.

• Able to participate collaboratively with all members of care team.

Additional skills:

• Excellent nursing assessment skills.

• Analytical thinking and problem-solving ability.

• Good verbal and written communication skills adaptable to individual levels of understanding.

• Proficiency in Microsoft.

• Basic knowledge of automated discharge planning via internet products.

Other Job Functions

Expected Behaviors :

• Respect – Treat all people well because all people have dignity; makes people feel welcome; recognize other’s point of view; responds to agreed upon time frames; show concern for one’s impact on others; exhibit mutual appreciation and respect for one another; exhibit appropriate phone and email manners; is responsive; all speech is appropriate (no unfounded criticisms, no offensive comments, no public arguing, no gossiping); before speaking ask if words are true or false, exaggerated or accurate, healing or cutting, grateful or complaining?

• Justice – Support, protect and promote the rights of all individuals and has a special concern for the poor and dying; raise issues/questions with the appropriate person; demonstrate concern for the rights of others; honor appropriate confidentiality; treat all customers and staff the same regardless of race, religion, ethnic background or socio-economic level; support privacy of others.

• Integrity – Demonstrate honesty and truthfulness in all dealings; maintain and protect confidentiality of organization information at all times; carry out responsibilities consistently; honor commitments and keep promises; maintain appropriate relationships.

• Stewardship – Dedicated to the responsible and creative utilization of our resources to assure the continuance of our mission; use time efficiently; respect other’s time and resources; set appropriate priorities for own work and those led; match resources with the need; treat all organizational property and resources with respect and care.

• Innovation – Continually search for new ways to profoundly improve our services; supports and is open to new ideas and approaches to meet people’s needs; suggest new ways of doing things.

• Compassion – Experience and express empathy with the life situations of others; give kindly care to all in focusing on the customer rather than the task; support others in need; serve others; listen actively and look directly at the person who is speaking; support others through changes that affect them.

• Quality – Continually improve our system’s processes of care and service to our patients, physicians, co-workers, and community through understanding needs and striving to exceed expectations; simplify systems; actively solicit opinions of others to improve the quality and value of services.

• Growth - Committed to the implementation of programs that inspire positive development in the organization, co-workers and community; is sensitive to the changes necessary to meet the challenge; identify strengths and assist in the development of others; seeks personal and professional development; offer to share knowledge and experience with others; think how work fits within the organization’s vision.

OTHER FUNCTIONS:

Perform duties and responsibilities in an ethical and responsible manner. Serve as a champion to assist medical and hospital staff to understand the principles of utilization review and case management. Is self-directed and seek opportunities to expand knowledge. Develop and foster an environment for success through team participation and active collaboration. Adheres to St. Francis rules, regulations, policies, values and mission statement. Continuously and effectively demonstrate the Health System’s customer service standards of courtesy, efficiency, safety, and presentation. Display a daily commitment to the values of the Care Management Department. Promote professional/personal growth of co-workers by sharing knowledge and resources. Attend all necessary ConnectCare® training necessary to perform daily duties. Perform other duties as assigned to ensure for continuation of the mission of Bon Secours. Able to maintain flexibility in work assignments and to assure responsibilities as part of job function. Attendance – must maintain timely, regular attendance. Punctuality. Professional appearance. Dresses according to Dress Code Policy Communicates well with patients, vendors, fellow employees, visitors and family members providing warm and friendly greeting and an approachable attitude. Answers questions when appropriate in a professional manner. RN-Care Managers have access to storage areas with minimal risk medications while performing job duties as assigned.

V.Working Conditions

Frequently subject to the following:

• Long, irregular hours:

• Varying and unpredictable stressful situations;

• Fluctuations in caseloads and patient types;

• Performance of duties under public scrutiny; and

• Constant interaction with patients, families, visitors, hospital staff, medical staff and community agencies.

Special Note : The following statement must be included in any position description if the employee may come into contact with human blood, body fluids and/or other potentially infectious materials in order to perform the job:

• The individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.

Other examples of Working Conditions statements include:

• Works in a normal office environment where there is no physical discomfort due to dust, dirt, noise and the like.

• Works in a patient care area where there is little exposure to dust, dirt, noise and the like.

• Travels outside the office in all weather conditions.

• Works in an area where there is potential radiation exposure, but is monitored by radiation badges.

Office Equipment Used

List any office equipment the incumbent will use, if applicable. Examples include: a telephone, a copier, a computer (keyboard, screen, printer), etc.

Physical Requirements/Hazards

• Complete the following charts regarding physical requirements and hazards.

• Mark an X in the “Some” column if an incumbent will perform this activity less than 33% of the time; mark an X in the “Freq” column if an incumbent will perform this activity more than 33% of the time.

• Fill in the appropriate % of time in the “Work Position” column.

Activity

Some

Freq

Work Position %

Lift

0-50 lbs.

X

Sitting

75%

Carry

0-50 lbs.

X

Walking

25%

Push

0-50 lbs.

X

Standing

5%

Pull

0-50 lbs.

X

Stoop, Kneel

X

Crawl

Climb

Balance

Physical Requirements

Hazards

Mark with an X if this is a physical requirement for this job.

Mark with an X if this is a potential hazard for this job.

X

Manual dexterity (eye/hand coordination)

Use of Latex Gloves

X

Perform shift work

Exposure to toxic/caustic/chemicals/detergents

Maneuver weight of patients

Exposure to moving mechanical parts

X

Hear alarms/telephone/tape recorder

Exposure to dust/fumes

X

Reach above shoulder

Exposure to potential electrical shock

X

Repetitive arm/hand movements

Exposure to x ray/electromagnetic energy

X

Finger Dexterity

Exposure to high pitched noises

Color Vision

Exposure to communicable diseases

Acuity – far

Blood born pathogen exposure

Acuity – near

Gaseous risk exposure

Depth perception

X

On Call

Notice of Employment At Will

This document does not create an employment contract, and employment with Bon Secours Health System is "at will."

Nor is this document an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the essential and non-essential functions of the job at any time or require that other or different tasks be performed when circumstances change (i.e. emergencies, changes in personnel, workload, rush jobs or technical developments). Management will attempt to give reasonable notice prior to revising a job function or requiring performance outside of this description.

Bon Secours Mission, Values, Customer Orientation and Continuous Quality Improvement Focus

It is the responsibility of all employees to learn and utilize continuous quality improvement principles in their daily work.

Consistent with the Company’s Code of Conduct, all employees are responsible for extending the mission and values of the Sisters of Bon Secours by understanding each customer, treating each patient, staff member, and community in a dignified manner with respect, kindness, and understanding and subscribing to the organization's commitment to quality and service.

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 recruitment@mercy.com . 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 recruitment@mercy.com