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Inpatient Care Manager

Umpqua Health


Location:
Roseburg, Oregon 97470
Date:
05/05/2017
Job Type:
Employee
Job Status:
Full Time
Categories:
  • Healthcare
Umpqua Health
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Job Details

Inpatient Care Manager

 

Position Purpose:

Inpatient Care Management nurse clinician would be responsible for the coordination of daily inpatient services and discharge planning in accordance with Umpqua Health policies and procedures.

 

Classification:  Full-time

Salary:  Competitive, DOE.

Benefit Package: Health Insurance, Life Insurance, Disability, 401(k), FSA, Holidays, PTO, and much more. 

 

Essential Responsibilities:

  • Conducting concurrent review to assess members for medical necessity by obtaining initial, concurrent or retro reviews for hospitalization including length of stay and level of care utilizing InterQual/Milliman guidelines.
  • Responsible to notify the Medical Director with cases that do not meet medical necessity for admission, length of stay or level of care.
  • In coordination with the hospital UR/Discharge Planner, ensure that an effective discharge plan is established.
  • Participate in Inpatient rounds daily and report any trends or provider issues. Identifies any significant gaps in Transitions of Care planning
  • Refer cases appropriately for care coordination services, High Risk, Homebound, Hospice/Palliative, Quality of Care concerns and Health Education.
  • Identifies and reports under-utilization and over-utilization of medical services, delays in service or treatment and quality of care issues to the Medical Director.
  • Actively participates in internal quality and work flow enhancement projects, and other duties, as assigned.
  • Aims for this program will focus on reduction in hospital readmission rates, optimization of the transitions of care measures as outlined in the Coleman Model for Transitions of Care, assessment of overall medical risk and successful handoff to Umpqua Health Case Management services to follow up with members deemed “at risk” for readmission, frequent/inappropriate ED utilization, inadequate access to primary care, ongoing morbidity associated with social determinants of health such as homelessness, mental illness, unemployment, lack of caregiver support, drug or alcohol dependency etc.
  • Other duties as assigned.

  Challenges:

  • This position is ideally suited for a qualified nurse clinician seeking a position that offers a wide variety of daily responsibilities, creative approaches to solve difficult issues well beyond the realm of chronic illness. This holistic approach to the member will demand the clear understanding that social determinants of health contribute to overall medical costs and morbidity much more significantly than the physical medicine issues with which the patient presents. Owing to the various complexities of physical, psychological and social factors, the workflows are often not “cookbook” but will require numerous ventures into the dynamic process of creative thinking and prioritization.
  • Working with a variety of personalities, maintaining a consistent and fair communication style. 
  • Satisfying the needs of a fast paced and challenging company. 

Requirements

Qualifications:

  • Current Oregon Registered Nurse licensure in good standings.
  • Minimum of three years in a practice or hospital setting.
  • Knowledge of medical group and hospital operations.
  • Attention to detail and strong organizational skills.
  • Communicate effectively with physicians and staff at all levels in the organization.
  • Strong problem solving skills and results-oriented.
  • Strong project management skills and the ability to motivate a diverse staff and interdisciplinary teams.
  • Familiarity with the complex needs of a population with multiple medical, social and psychological obstacles to achieving and maintaining wellness and stability in the community.