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Case Manager - Hospital - RN / Registered Nurse

Location: Englewood, Colorado;

Job ID : 3403621


Responsible for facilitating a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy in order to promote optimal clinical outcomes within hospital operations/services. The Acute Care Team (ACT) nurse will insure appropriate utilization of covered services by making it effortless for the member to receive the services required to treat the member's condition(s), and comply with the physician's care plan. This includes transitions between care settings (e.g. inpatient, outpatient and other settings such as home care, palliative care, physical therapy, etc.), cross-market coordination, complex case management and promotion of preventive services.

Essential Responsibilities:
- The applicant must have the ability to develop strong relationships of trust, effective interpersonal skills, and communication in a collaborative environment with CPMG and network providers, leaders, and colleagues.
- Routinely assess and monitor hospitalized member's status, needs and progress; proactively encourages appropriate adjustments to member care plans, providers and/or services to promote better outcomes. This position is accountable for synthesizing data from multiple sources including face-to-face interaction with members to develop a coordinated patient plan of care and to implement in collaboration with patients, providers and multidisciplinary teams.

- Determine and manage appropriate levels of care management, support, and services to members by using clinical knowledge, established guidelines, and physician consultation. Synthesizes and analyzes a large volume of data related to the member, benefits, eligibility, facilities, contracts, and clinical status to identify issues and facilitate problem solving.
- Provide assessment and management of critical transition both within and from hospital to home using evidence based guidelines that ensure a safe transition and excellent outcomes for the member.
- Coordinate care with various internal and external customers to facilitate high quality, timely care and service.
- Must be able to navigate hospital based Electronic Medical Records (EMR's) and EPIC Health Connect to document appropriate ACT notes.

Qualifications: Basic Qualifications:
- Minimum one (1) year of case management/care coordination experience with most recent experience within the previous five (5) years managing medically complex patients. Education

- Associate's degree in nursing (Graduate of Board approved and accredited RN program). License, Certification, Registration

- Active, unrestricted Colorado RN License
- BLS Certification (American Heart Association) within 2 weeks of hire.
- National Provider Identifier (NPI) and Taxonomy code required at time of hire.
Additional Requirements:

- Must be able to achieve eDHP credentialing within all hospital locations, and other locations as assigned. BLS Certification (American Heart Association) within 2 weeks of hire.
Preferred Qualifications:

- Minimum one (1) year Med-Surg nursing experience in the hospital setting with most recent experience within the previous five (5) years strongly preferred.
- Minimum one (1) year Hospital Case Management preferred managing medically complex patients (e.g., ICU, Med-Surg, Orthopedic, Pediatrics, NICU, Surgical, Oncology)
- Bachelor's degree in nursing (Graduate of Board approved and accredited RN program).
- Certification in Case Management preferred and encouraged.
- Knowledge of utilization management/review, discharge planning, and Interqual / Milliman / CMS criteria guidelines preferred.

Position will be required to float between All Denver/Boulder Core hospitals: Swedish Medical Center, SkyRidge Medical Center (Primarily) plus St. Joseph Hospital and Good Samaritan Hospital in Lafayette to cover staffing as needed based on census and depatmental needs. Position will require credentialing and privilages at Swedish Medical Center and SkyRidge Medical Center.

Primary Location:Colorado,Englewood,Swedish Medical Center - 601 601 E. Hampden Ave.

Scheduled Hours (1-40):40


Working Days:Variable


Job Type:Standard

Employee Status:Regular

Employee Group:UFCW - Local 7

Job Level:Individual Contributor

Job:Nursing Licensed

Public Department Name:Hospital Operations

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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