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Case Manager-Lead

Banyan Medical Systems Omaha, NE
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Job Description

COMPANY BACKGROUND

Banyan Medical Systems, Inc. is headquartered in Omaha, Nebraska. We design, develop, produce, sell, and support custom Healthcare IT solutions. Our work focuses on the integration of real-time data streams in support of providing care givers, patients, and family members access to coordinated, holistic care information. We currently offer configurable solutions for procedural area integration (e.g. operating rooms), fall prevention, virtual care teams, and multi-source audio/video collaboration. In addition, we offer scalable custom solutions for addressing room to enterprise level collaboration needs.  Banyan Medical Systems 

is an innovative Digital Healthcare provider looking for dynamic, energetic, accountable, and highly self-motivated individuals to join our team.

LOCATION

Managed Services Operation Location: Banyan Headquarters

SUMMARY

Banyan Medical Systems is looking for professionals in the healthcare field who can learn the Banyan products and provide virtual care services to the Managed Services Clients.  As a member of the Managed Services team, the Virtual Case Manager will coordinate the plan of care and provide comprehensive care coordination and oversight of patient’s care remotely on the Managed Services Clients’ inpatient unit(s). The RN Virtual Case Manager, in collaboration with members of the inter-disciplinary healthcare team, leads the development and implementation of the multidisciplinary plan of care for patients, determining appropriate patient status and level of care; ensuring effective quality and cost-efficient outcomes by performing concurrent and retrospective case review, and supervising the provision of the discharge plan of care. This position functions as the key linkage between the physician, staff, and hospital leadership in the day-to-day management of appropriate and efficient patient care and functions as an advisor to the physician with accountability to escalate cases to the Medical Director (as necessary) to ensure the provision of appropriate and effective patient care. 

The Virtual Case Manager will collaborate with the multidisciplinary team, including Physicians, Registered Nurses, technicians, and other healthcare providers, for care coordination, education and virtual assessments on admission and discharge. The Virtual Case Manager will also be responsible for monitoring quality metrics specific to the department and ensuring complete and accurate documentation in the patient record of the data collected for those metrics. A high degree of professional competence and autonomy will be demonstrated in performing the roles of 1) clinician, 2) educator, 3) consultant/collaborator, and 4) navigator. 

The Virtual Case Manager is responsible for the assessment, planning, implementation, coordination, monitoring and evaluation of the patient's plan of care from admission to post-discharge. The Virtual Case Manager utilizes clinical knowledge, critical thinking skills, and the principles of case management to coordinate and implement a discharge plan that meets the patient's needs and ensures a seamless, effective, and efficient transition of care across the continuum.

PREREQUISITE SKILLS: Case Manager

•Must have the ability to read, write, and follow English verbal and written instructions, and have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, and positive personal influence and negotiation skills.

•Leadership skills to delegate, functionally supervise, provide direction/guidance to staff and hold others accountable are required.

•Must have the ability to work independently with a minimum of direction, anticipate and organize work flow, prioritize and follow through on responsibilities.

•Must have strong clinical assessment and critical thinking skills necessary to provide utilization review/discharge planning services appropriate to patients with   complex medical, emotional and social needs.

•Strong attention to detail and accuracy is required.

•Must have the ability to work in a high-volume case load environment and deal effectively with rapidly changing priorities.

•Demonstrated ability to work constructively with a broad spectrum of health care professionals is required.

•Must be assertive and creative in problem solving, system planning and management.

•Proficient computer skills are required including use of Electronic Health Record and other IT applications.

•Must be effective as both a team member and a leader.

KNOWLEDGE

•General knowledge of supervisory principles/applications is required.

•Must have a working knowledge of disease processes, current treatments and their physical and psychosocial sequelae.

•Knowledge of individual and family development over the life span is required.

•Knowledge of the influence of cultural and spiritual values on health care is required.

•Basic knowledge of applicable laws, regulations, and accreditation guidelines (e.g. CMS, DHS, Joint Commission, EMTALA) is required.

•Basic knowledge of government and private insurance benefits (e.g. Medi-Cal, Medicare, DRGs, managed care, capitation), including reimbursement requirements is needed.

•Must know child, elder and dependent adult and domestic violence reporting requirements.

•General knowledge of available health care and community resources appropriate for populations served is required, broad/in-depth knowledge is preferred.

•Working knowledge of Inter-Qual criteria.

ESSENTIAL FUNCTIONS (not modifiable) Care Facilitation and Coordination:

•Coordinates care for an assigned unit-based patient population in a paired team model comprised of RN Case Manager and MSW Social Worker.

•Works with the multi-disciplinary healthcare team to ensure the plan of care is expedited and barriers to efficient throughput are identified and corrected.

•Creates a plan of care that outlines the key interventions and outcomes to be achieved each day of the inpatient stay. “Plan for the day – plan for the stay”

•Can actively lead multidisciplinary case conferences in developing comprehensive, cost-effective case management plans that span the continuum.

•Makes independent assessments and recommendations regarding course of action in complex situations and recommendations relevant to multi-system or   special needs Patients.

•Identifies and refers quality and risk management concerns to appropriate level for corrective action plans and trending.

•Proactively solicits physician’s orders for services.

•Demonstrates knowledge and skills necessary to provide cultural, spiritual and age specific care by obtaining specific care information and assessing relevant information needed to identify each patient’s unique treatment and discharge planning needs

Utilization Management Specific Interventions 

•RN Case Manager completes an admission review using standardized criteria (Inter-Qual) within 24 hours of admission and documents review outcome.

•Escalates to the Physician Advisor when criteria are not met and attending physician disagrees with findings.

•Completes a continued-stay review according to policy to assure patient is at the appropriate level of care.

•Monitors the length of stay in comparison with MS-DRG/GMLOS for all patients.

•Completes concurrent review for specified health plans and includes medical necessity documentation to avoid payor denials.

•Ensures that the patient is transitioned to the next level of care as quickly as possible once the patient no longer meets clinical criteria for the current level of care.

•Works with physicians and CDI to ensure that clinical information available in the medical record is accurate and reflects the care rendered to the patient.

•Collaborates with physicians to determine appropriate levels of care for post hospital care, use of hospital resources, and available community resources.

•In a timely manner, communicates pertinent information to third-party payers and managed care organization to obtain authorization for care and prevent denials.

•Reviews, processes, and issues denials to client/responsible party following regulatory guidelines and facility protocols. Informs client/responsible party of right of appeal and the appeal process. Collects data for the appeals process.

•Identifies avoidable days, intervenes to correct delays, and enters outcomes in MIDAS in a timely manner according to policy and procedure.

•Uses personal judgment within broad guidelines to initiate review of inappropriate utilization by physicians and follows-through to resolution (e.g., attending, department chair, utilization management medical director).

Assessment/Care Coordination/Discharge Planning

•Completes an initial discharge planning assessment within 24 hours of admission and documents findings in the CM-Assess tab in the electronic health record.

•Reviews initial hospital admission and gathers additional medical, psychosocial and financial data from needs assessment, client/family, physicians, and other   health care providers. Determines risk level and identifies client’s service needs.

•Performs AUDIT (Alcohol Use Disorder Identification Tool) for patients assessed on admission to be at risk based on standardized criteria.

•Formulates a discharge plan after completing a face-to-face interview and discusses available/appropriate care options and obtaining input from the patient/family and physician, healthcare team, insurance companies, and community-based support services.

•Collaborates with physicians to facilitate timely resolution of situations such as client concerns, need for referrals and discharge barriers to expedite the discharge  plan.

•Acts as a resource and content expert for the physicians regarding an optimal care plan for patients.

•Identities potential problems, prevents and/or resolves variances to the case management plan. Effectively deals with resistance and conflict in working with   member of the patient care team, physicians, clients, and families.

•Implements all aspects of the discharge plan of care, intervening in an appropriate and timely basis when difficulties arise. This may require documentation and follow-up with other management staff to ensure effective resolution.

•Mobilizes resources to effect rapid and timely movement of the patient through the system to achieve targeted discharge times established by MGH policy.

•Identifies and mobilizes patient’s and family’s strengths to optimize use of healthcare and community resources. In coordination with patient/family wishes,   guides/assists in securing needed post discharge services, which may require negotiating for services covered but not readily  available.

•Implements the discharge plan to include all the necessary referrals and authorizations as identified by federal, state, and local insurance regulatory agencies   and offers patient choice per regulatory guidelines.

Department Operations and Professional Development

•Actively participates in department meetings and operations, including process development or improvement (e.g., department orientation, internal   mentor/training programs and initiates, disease and population management strategies, appropriate measures for evaluation of  outcomes) and establishment of   department goals, objectives, and budget.

•Ensures all applicable department and regulatory targets for productivity and department performance process improvement are attained (e.g., hospital length of   stay, average cost per discharge, and re-admission rates, etc.).

•Complies with all reporting requirements for mandated, risk management, and other medical/legal situations consistent with confidentiality policies and   department standards.

•Actively contributes to the development and maintenance of a care delivery system which is sensitive to individual patient needs, promotes effective resource   utilization, and supports physician practice, while emphasizing coordination across the continuum.

•Positively contributes to team’s decision-making process, effectively collaborates with other team members on interdependent tasks, and actively supports   implementation of plans to accomplish team objectives.

•Prepares and conducts presentations to multidisciplinary teams related to special projects, case management, etc.

•Adheres to department and facility policies and procedures and supports philosophies and initiatives.

•Maintains accurate, current, and legible patient records using approved forms and format, according to department and entity standards, including patient   assessments, plans, interventions, patient/family involvement, outside agency communications, and interdisciplinary contacts.

SECONDARY FUNCTIONS (modifiable); RN Case Managers

•Actively participates in ongoing department interviews for RN/SW Case Managers and Department   Assistants, effectively recommending selected applicants for hire.

•Recommends or provides necessary training to staff.

•Attends and participates in community-based committees and task forces, when applicable and staff is available.

•Other duties as assigned.

QUALIFICATIONS

• Education: Must be a graduate of an accredited college of with a Bachelor of Science degree in Nursing preferred

Experience: 

• One (1) + year Acute Inpatient RN Case Manager experience performing both UR and discharge planning for a patient caseload. Substantial recent experience    in utilization review and/or discharge planning in an acute care setting is strongly preferred.

• Three (3) or more years of RN experience in an acute patient care setting, preferably in medical/surgical or critical care.

• Broad nursing clinical background strongly preferred.

• Experience working efficiently with multiple computer applications in a fast-paced work setting

• Experience demonstrating leadership skills and inter-disciplinary collaboration preferred.

• License/Certifications: National certification (ACM) in Case Management preferred.

• Special qualifications: Manage and communicate data and information in clinical informatics work environment to Managed Services Clients, nurses, health care   providers and patients. Act as the liaison between health care providers and technology staff. Must be able to successfully  complete established       competencies for the position within designated probationary period.  Effective communication skills; both orally and written.  Computer skills needed.  Ability to   manage and work with others within a team to ensure quality patient care.  Strong critical problem-  solving skills. Ability to respond to common inquiries or   complaints from customers or regulatory agencies. Ability to lead, plan and delegate tasks appropriately. Ability to define problems, collect data, establish facts   and draw valid conclusions. Ability to work independently and under      pressure. Knowledge of government and third party reimbursement systems and   contracts.

• Hours of work:  PRN, Part-Time and/or Full-Time Non-Exempt

• Experience and knowledge of the following Microsoft System: Active Directory, Exchange, Skype for Business, and Office 365

ORGANIZATIONAL COMPETENCIES

Value Behaviors:

It is essential that associates can support the values of Banyan and Managed Services Clients, and interact effectively with physicians, patients, residents, visitors, and staff. Each associate is expected to demonstrate a commitment to core values, standards of behavior and professionalism through appropriate conduct and demeanor always.

Security Access: Confidential Information:

Employees in this position have access to protected health information. The protected health information a person in this position can access includes demographics, date of service, insurance/billing, medical record summary information, and all other information that may be contained in patient records.  This position requires patient health information to perform the functions outlined as part of this position description.

Ages of Patients Served

• Infants (Birth up to 1 yr),

• Toddlers (1yr up to 3 yr), 

• Preschool children (3yr up to 6yr), 

• School Age Children (6yr up to 12yr), 

• Adolescent (13 yr - 18 yr), 

• Early Adult (18 yr - 45 yr), 

• Middle Adult (45yr up to 61yr)

• Late Adult (61 yr up to 80 yr), 

• Late, Late Adult (80 yr+)

Employees in this position must be able to demonstrate the knowledge and skills necessary to provide care and/or service based on the physical, psycho/social, educational, safety, and related criteria appropriate to the age of the patients served in his/her assigned service area.

 

Physical Requirements

? Sedentary Work - prolonged periods of sitting and exert/lift up to 10 lbs. force occasionally

? Light Work - exert/exert/lift to 20 lbs. force occasionally, and/or up to 10 lbs. frequently

? Medium Work - exert/exert/lift to 50 lbs. force occasionally, and/or up to 20 lbs. frequently, and/or up to 10 lbs. constantly

? Heavy Work - exert/exert/lift to 100 lbs. force occasionally, and/or 50 lbs. frequently, and/or 20 lbs. constantly

? Very Heavy Work - exert/lift over 100 lbs. force occasionally, and/or over 50 lbs. frequently, and/or over 20 lbs. constantly

Mental/Emotional Requirements

? Manages stress appropriately

? Makes decisions under pressure

? Manages anger/fear/hostility/violence of others appropriately

? Handles multiple priorities

? Works independently

? Work in confined/crowded areas

Performs duties while constantly prioritizing and organizing his/her work.  This position requires continuous, efficient time management.  Frequently, RN/SW Case Manager exercises independent judgment and discretion to choose optimal solutions and prioritize his/her work.  A person operating within this job description must display appropriate interpersonal skills while working productively and efficiently in a team.  The RN/SW Case Manager must maintain his/her emotional stability to concentrate on tasks, comprehend written communication or oral instructions.  This position occasionally requires tolerance of stress and frustration. Requires continuous maintenance of attention span and use of cognitive skills. Interruptions by telephone, or interpersonal communications require that the Case Manager effectively transfer from task to task.  This position requires a high level of professional decorum appropriate to the mission and scope of department function and the confidence of the staff.  Patient confidentiality must be continuously observed.

TASK BEHAVIOR

• The ability to constantly follow direction with high attention to detail is critical and essential to patient safety.  Maintaining an emotional balance under the      pressures of workload fluctuations and frequent interruptions is required.

• The initiation of a task occurs frequently during the work shift.  Tasks are shift area specific and involve staff consultation, physician interaction, email communication, telephone calls, sending electronic referrals.

• Concentration is required continuously during the work shift.  Although interruptions occur occasionally, task concentration is essential

• Frequently, the RN Case Manager must follow written directions while executing Policies and Procedures, reading memos and email.  This activity is exhibited by the ability to remember and execute written instructions and seek direction as appropriate

• Frequently the RN Case Manager must follow oral directions via communication from management inside and outside the department.  This activity is demonstrated by the ability to remember and execute oral instructions and seek direction as appropriate

• Attention to detail and neatness is required continuously.  This activity is evidenced by preciseness in task performance and orderliness of the work area

• Problem solving, and judgment is required frequently in response to queries from coworkers and staff, inside or outside the department.  The RN Case Manager must base the response or query redirection on knowledge of applicable laws and regulations, policies and procedures and   personal database.  Occasionally, this position must resolve problems of a technical or personal nature

• A continuous, elevated attention span is required throughout the work shift

• The organization of tasks via a systematic approach to changing priorities occurs continuously within the framework of the workload of demands

• Initial learning and memory retention are frequently summoned due to changes in practice to department activity.  The RN Case Manager must be capable of applying new information promptly and consistently

• The RN Case Manager must seek to provide support to other team members

• The continuous motivation to complete tasks is required and this activity is exhibited by the initiative to seek thoroughness and follow-through while performing assignments

• Decision making occurs frequently within the framework of the workload demands, while exercising cognitive skills and determining optimal solutions to problems and then, setting priorities.  The RN Case Manager makes decisions within certain prescribed limits.  This decision   making involves good judgment and embraces independence of thought or exercise of significant subjective discretion

• Frustration tolerance is frequently required during the work shift

 INTERPERSONAL AND COMMUNICATION SKILLS

• Develops and maintains positive, productive relationships with healthcare team members and representatives of community agencies.

• Develops and maintains positive working relationships with hospital unit staff and management.

• Relates with tact and respect to internal and external customers with diverse cultural and socioeconomic backgrounds, some of whom may be exhibiting varying    levels of distress.

• Actively builds positive relationships with internal and external customers.

• Uses effective communication skills with colleagues to resolve issues in a timely, positive, and productive manner.

• Willingly provides and accepts direct and constructive feedback to and from colleagues.

• Flexibly adapts to changes in the work environment and resolves issues related to assignments and department functioning in a timely, positive, and effective        manner.

Hazards

? Exposure to toxic/caustic chemicals

? Exposure to extreme conditions; hot/cold

? Exposure to dust/fumes/gasses

? Exposure to electrical shock

? Operation of heavy equipment

? Exposure to moving mechanical parts

? Exposure to x-ray/electromagnetic radiation

? Exposure to high pitched noises

? Exposure to communicable diseases

? Exposure to blood and/or body fluids

? Exposure to excessive sunlight or work outdoors

? Unprotected heights

? CRT (computer monitor)


 

Job Details

Date Posted November 27, 2018
Date Closes December 29, 2018
Address 8701 F St
Located In Omaha, NE
Job Type Full-time Employee
Start Date 2019-01-01
SOC Category 11-9111.00 Medical and Health Services Managers
Zipcode 68127
Name Veronica Fichtl
City, State and Zip Omaha, NE 68127

This job offers the following benefits

  • 401(k) Retirement Savings Plan
  • Dental
  • Life Insurance
  • Long-Term Disability
  • Medical
  • Short-Term Disability
  • Vision
  • Voluntary Life Insurance
  • Bereavement Pay
  • Casual Dress
  • Paid Holidays
  • Paid Vacations

This job requires the following skills

  • EMR/HER Software
  • Epic EMR
  • Healthcare IT Technology
  • Healthcare Software
  • Medical Office Software
  • Medical Technology

This job is related other jobs in these career categories

Course(s) relevant to the skills listed for this position

At a Glance
Enjoy these benefits
  • 401(k) Retirement Savings Plan
  • Dental
  • Life Insurance
  • Long-Term Disability
  • Medical
  • And More ...
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