RN Care Manager- Inpatient Rehab

Location Site: Rehab

Department: SH B4 N Inpatient Rehab

Position Type: Part Time

Start Time: 7:30

Pioneering healthcare since 1896, Salem Health is a top workplace offering highly competitive pay where you can make a difference in the lives of those in the community where you live. Through incorporation of Lean driven principles, staff are able effect change in the organization to solve problems, and drive continuous improvement.

As an employer of choice, we are devoted to assuring that we provide a safe, healthy, and patient-centric workplace, while keeping staff wellbeing and satisfaction top of mind.

We invite you to learn more about our wonderful community: There’s something about Salem, Oregon!

Your Role With Us:

Essential Duties and Responsibilities 20%:

1. Completes an initial screen of patients within 24 hours of admission utilizing specific criteria to identify needs related to utilization management and/or discharge planning and to identify patients in high risk categories. Refers appropriate cares to Social Work based on established referral criteria and professional judgment.

2. Responsible for care coordination and discharge planning for assigned patients.

3. Collaborates with the patient/family and all members of the multidisciplinary team to facilitate the care management and care coordination processes for the assigned caseload.

Care Coordination 20%:

1. Uses clinical knowledge to assess and intervene as needed regarding patient’s treatment plan, care trajectory, and post-acute needs.

2. Identifies and addresses the needs of high-risk patients to promote coordination of services and to prevent re-admissions or repeat Emergency Department visits. Strategizes with physicians, other team members, payers, and administration to develop appropriate care delivery strategies for these patients.

3. Takes the lead in identifying and addressing the needs of patients experiencing re-admission and/or unexpected long lengths of stay.

4. Identifies patients and families with complex psychosocial issues and refers them to the Social Worker as appropriate.

5. Is an active participant and/or leader in Care Coordination and Complex Care/Long Stay Rounds.

Management of Resources and Utilization 10%:

1. Has a working knowledge of different types of statuses such as inpatient, observation and outpatient procedure. Discusses appropriate status with MD and Utilization Review RNs (UR RNs).

2. Provides Condition Code 44 to patients when required. Follows the hospital’s procedure to do this.

3. Following hospital procedures, administers HINNs and ABNs and delivers the Medication Important Message. Communicates with the patient’s physician when a HINN or ABN is needed.

4. For patients in the Emergency Department: a. Meets with Patients in regard to appropriate use of ED and prescribing of controlled substances from the ED b. Contacts the PCP’s office in regard to patients’ presentations to the ED consults with PCP’s in regard to patients’ presentations and makes recommendations in regard to management of chronic/routine health care issues on an outpatient basis. c. Develops ED CM plans for patients who present to ED inappropriately.

Management of Patient/Family Transitions and Discharges 40%:

1. Assesses the patient/family for care needs at admission, during and following hospitalization to establish an effective discharge plan in collaboration with the multidisciplinary team.

2. Collaborates with the patient/family and the health care team to identify the most appropriate post acute site of care and/or services. Uses the hospital’s Choice Policy to request patient/family input into the selection of post-acute services and sites.

3. Aligns patient resources (including payment source) with the discharge plan.

4. Identifies potential barriers to discharge or transfer and communicates them to the care team to spearhead resolution of the issues where possible.

5. Refers to and consults with medical staff and other internal staff as needed to assure appropriate and timely discharge.

6. Monitors the patient’s progress and plan of care with the aid of internal and external clinical and utilization guidelines. Reports issues and system barriers to efficient and effective discharge planning to the Care Management leadership.

7. Ensures appropriate transfer of Care Management related patient information to post-acute providers.

8. Manages patients in the Emergency Department who, when not appropriate for a hospital level of care, can be triaged directly to home care, inpatient rehabilitation, a medical geriatric assessment program, or other providers

Additional Accountabilities 10%:

1. Collaborates and communicates with the patient’s interdisciplinary team.

2. Documents in the patient record according to department policies and procedures.

3. Informs the patient and/or next of kin when Medicare coverage must be terminated for the current admission. Issues the termination letter for Medicare patients following established hospital policy.

4. On an individual care basis, develops a strategy with the Care Management leadership to address situations in which a third party payer is issuing a termination of benefits notice.

5. Educates staff and physicians about managed care principles, observation service, and discharge planning.

6. As a member of the Care Management practice: Seeks and provides peer consultation about patient situations that are presenting difficulty and/or experiencing significant deviation from the plan of care. Participates in quality improvement and evaluation processes related to the Care Management practice.

Total Rewards Offerings:

Salem Health's comprehensive benefits package prioritizes your mental and physical health, financial stability, family obligations and professional growth.

• Relocation assistance available for qualified positions
• Full comprehensive medical, dental, and vision plans
• Basic and voluntary life insurance
• Short and long-term disability
• Live Well Wellness Program
• Employee Assistance Program (EAP)
• 401(K) retirement plan with employer contributions.
• Generous paid time off (PTO) accrual and holiday pay
• Onsite fitness center with 24/7 badge access
• Education assistance program
• Public service loan forgiveness (PSLF) eligible employer https://studentaid.gov/
• Food and drink discounts in the cafeteria
• Impressive discounts offered by Nike, Adidas, Carhartt and others

Background/Expertise:

• Associate Degree of Nursing (ADN) - ADN with 5 years of experience working of acute care RN experience or care manager, or ADN with an agreement to complete BSN or MSN within 2 years of hire REQUIRED
• BSN or BAN or MSN or non-nursing bachelor’s degree with MSN may be accepted in lieu of ADN.
• Basic Life Support Credential REQUIRED
• Registered Nurse - Current unencumbered licensure to practice nursing as a Registered Nurse in the State of Oregon REQUIRED.
• Minimum one (1) year of acute care RN Staff Nurse experience REQUIRED
• Care Management experience PREFERRED

Salem Health Hospitals and Clinics is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, genetic information, or any other status or condition protected by law.

Salem Health Hospitals and Clinics is committed to providing access, equal opportunity and reasonable accommodation for applicants. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact my.recruiter@salemhealth.org