Case Management - Case Manager

*This is a safety sensitive position* 

Wage Scale: $42.59-$59.63

Your experience matters 

At Trios Health, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. Here, you’re not just valued as an employee, but as a person. As an RN Case Manager joining our team, you’re embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve. 

Essential Functions 

• Perform chart review to identify and assess patient needs.
• Oversee education regarding financial assistance when needed, i.e. public benefit programs, community resources & support programs, rehabilitation services to attain patient planned outcomes.
• Coordinate, facilitate and lead patient care conferences on complex cases involving interdisciplinary team members.
• Utilize effective communication skills to resolve issues that are in the client’s patient’s best interest.
• Discuss both acute and chronic health issues Utilization Management
• Screen all patients to ensure correct admission status according to clinical appropriateness, i.e., inpatient, observation, at the time of admit or as soon as possible after admit.
• Maintain knowledge of Medicare, Medicaid and other third party reimbursement methods and contract requirements
• Facilitate observation patient flow documenting according to Policy and Procedure
• Ensure patient is in the appropriate status during hospital stay according to the prescribed clinical plan of care utilizing InterQual criteria as a guideline
• Make timely referrals to a physician advisor to expedite the patient’s plan of care as indicated. 
• Clinical Monitoring and Evaluation
• Obtain payer contact information and enter into computer
• Communicate reimbursement information to the patients and families as needed
• Utilize clinical expertise, analytical skills and InterQual criteria to determine level of care and admission status
• Interface with respective payer representatives
• Responsible for the analysis of clinical information
• Monitor the appropriateness of patient status
• Analyze case management outcome data
• Act as a resource in the appeal and denial process
• Educate physicians, patient care coordinators, hospital staff, patients and families regarding criteria.
• Collaborate with payers for authorizations for patient benefits and transfers providing options and alternatives as appropriate.
• Maintain Utilization Management records in accordance with state, federal or other regulatory standards.
• Participate in Quality Improvement activities within the organization Provide Trios Health patients with a plan of care prior to discharge.
• Maintains ability to establish and maintain a therapeutic relationship with patients, families, caregivers
• Maintains ability to develop and maintain rapport, non-judgmental, accepting, and respectful of patient/family individuality and rights

Qualifications and requirements 

• Associate’s degree in nursing - Required
•  Bachelor’s degree - Preferred
• Active Washington state RN Licensure or compact license
• Home Health Care: One year experience in an acute care setting
• Basic Life Support ( BLS)

Benefits:     

Medical Insurance: Savers, PPO, PPO Plus offered through Blue Cross Blue Shield   

Dental Insurance: Offered through BCBS   

Vision Insurance: Offered through BCBS   

Free EAP (Employee Assistance Program)    

Paid Time Off (Up to 25 days a year)   

Employer Paid Short-Term    

Coverage options for Medical, Dental and Vision include: Employee, Employee & Spouse/Domestic Partner, Employee & Child, Family 

Salary : $43 - $60