Utilization Review RN Case Manager

At Snoqualmie Valley Health, we’re not just in the business of healthcare; we’re in the business of empowering our community to live boldly and live well. Our commitment to excellence and innovation calls for team members who will build trust, obsess over excellence, lead innovation, and deepen connections within our community. We are guided by our core values, and we’re looking for someone who can embody those principles as part of our dynamic and growing team.

Located in a trailblazing, adventure-loving town at the base of the Cascades, Snoqualmie Valley Health is an independent public hospital district serving a vibrant community that thrives on both adventure and connection. This is more than a job—it’s an opportunity to be part of something bigger.

FTE 0.6

OBJECTIVE SUMMARY:  The Case Manager RN assesses, plans and evaluates the care of a designated case load of patients to assure that clinical and financial outcomes are fully met.  The Case Manager RN will perform review of referrals, chart documentation, insurance coverage, and other relevant information to assure patient care meets the reimbursement requirements to justify admission, treatment and length of stay.  This position communicates with the Multidisciplinary Care team to assure timeliness of eligibility, length of stay, and impacts to the discharge plan.

This position works in collaboration with Social Work, Nursing, Hospitalist, and Rehabilitation to assure an appropriate plan of care and discharge planning is initiated and managed in a timely manner.

ESSENTIAL FUNCTIONS:

• Oversees and monitors care delivered to assigned caseloads from referral through discharge planning
• Maximizes positive financial outcomes assuring patient charges are accurate and thoroughly documented
• Monitors admission and continued stay criteria for all payers and responds to requests related to claims, denials, appeals and quality concerns
• Contributes to treatment and discharge plans to maximize patient outcomes, quality of care, and use of resources.
• Monitors patients to assure appropriate admissions, length of stay, and any potential denial of payment issues
• Evaluates documentation regarding severity of illness and intensity of service for variation from regulatory standards.
• Performs routine auditing of charts, patient documentation, care and discharge plans to assure compliance with industry and payer standards
• Participates in weekly multidisciplinary care team meeting, and other committees as assigned
• Participates in daily huddles and patient care conferences as assigned

REQUIRED EDUCATION: WA RN license

PREFERRED EDUCATION: RN minimum, BSN preferred; case management certification preferred

REQUIRED EXPERIENCE: Minimum three years of previous experience in a hospital or institution

PREFERRED EXPERIENCE: Knowledge of Medicare Swing Bed program

WORK ENVIRONMENT: Hospital inpatient setting

PHYSICAL DEMANDS: Assist with moving and transferring patients (involves pushing and pulling). Natural or corrected near-visual acuity is necessary to read patient charts, physician orders, computer screens. Natural or corrected hearing is necessary to communicate effectively with others.

BENEFITS:

We take pride in the benefits package we provide our team members. Snoqualmie Valley Hospital offers you one medical plan with multiple in-network tiers with Snoqualmie Valley Hospital, Eastside Health, and First Choice/First Health providers/network.

• Medical
• Dental
• Vision
• Pharmacy
• Health Reimbursement Account (HRA)
• Life and AD&D
• Retirement Plan
• Employee Assistance Program (EAP)
• Flexible Spending Account (FSA)
• Travel Assistance & ID Theft Protection
• Voluntary Benefits
• Tuition Reimbursement

Eligibility Requirements - Employees regularly scheduled at least 20 hours per week.

Employee Dependents - Your legal spouse or domestic partner, Dependent children until age 26.

Waiting Period - 1st of the month following your date of hire.

PLEASE NOTE:

• The COVID vaccine and the Flu shot (during Flu season) are a condition of employment.

• Snoqualmie Valley Hospital is a drug-free workplace. We complete drug screenings as a part of our onboarding process.

Salary : $40 - $65