Pacific Medical Centers Care Manager (RN) - Internal Only in Seattle, Washington
Find what you’re looking for in your career at PacMed as a Care Manager (RN) (0.0 FTE, Day Shift) to work in Accountable Care at Pacific Medical Centers in Seattle, WA.
Coordinates care for Pacific Medical Centers' Managed Care patient in order to assure cost effective, appropriate utilization of health care resource. Nurse Case Manager manages, directs, and coordinates the entire spectrum of care for patient throughout a variety of settings, both inpatient and outpatient. This position assists physicians (internal and external) with management and coordination of care. Works at varied clinic and provider locations as needed.
In this position you will:
Oversees the utilization of resources involving hospital care; tracks utilization using tools such as ISD criteria’s Milliman and Robertson; intervenes when inappropriate utilization identified by making recommendations to attending provider and referring noncompliance to Medical Director; recommends and implements alternatives to hospital using financial management skills and interpretation of benefits; identifies delays with hospital management and intervenes to resolve delays.
Creates discharge plans for patients in skilled nursing facilities and hospitals; collaborates with physicians to identify plan of care for admission including expected outcome of treatment; assesses patients and facilitates a decision to determine disposition of patients on discharge; coordinates discharge plan with patient families to assure timely and successful discharge; advises patients and families regarding benefits, resources, and home management options.
Is accountable for appropriate referrals for homecare and DME with identified case load; assesses and determines homecare for patients when hospitalized; responsible for ordering homecare and durable medical equipment; maintains a sophisticated knowledge of benefits, services, agencies and community resources available.
Recommends care plan for high risk patients in the outpatient setting including communication with physicians, nurses, homecare providers or others as applicable.
Collaborates with the physician or provider regarding appropriate disposition of patients from hospital or specialized nursing facility; educates and directs providers both within and outside the Pacific Medical system regarding benefits and utilization of services; directs case managers from outside facilities regarding: use of benefits and discharge planning options; consults with Medical Director regarding complex cases and discusses appropriateness of hospitalization or care in skilled nursing facility; identifies issues with Pacific Medical system to facilitate patient care (barriers to patient care).
Acts as a resource for clinical care plans; Risk Contracts/ACO and Medicare benefits and guidelines to coordinate patient care; advises patients and families regarding benefits, limitations, and appropriate use of resources.
Required qualifications for this position include:
CPR or BLS certification within 6 months of hire.
Current Washington State Registered Nurse License
Preferred qualification for this position include:
Bachelor's Degree in Nursing
2 years clinical experience
Experience in utilization review/case management
Certified Case Manager
Ability to use an Electronic Medical Records (EMR) system
Pacific Medical Center:
Pacific Medical Center is an expanding network of outpatient clinics providing primary and specialty care to the greater Seattle area and employing more than 150 providers representing most medical specialties. Pacific Medical Centers is affiliated with Providence Health & Services, which operates 28 exceptional not-for-profit hospitals and more than 350 clinics across the West. With hundreds of physician and advanced practice provider opportunities in virtually all specialties at any given time, Pacific Medical Centers and Providence offer diverse locations, lifestyles and practice models. Find what you are looking for in your next practice opportunity with Pacific Medical Centers! Learn more at www.pacmed.org/providerjobs .
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit https://pacmed.jobs/benefits/
Our mission is to provide respectful, high-quality, patient-focused healthcare to each person and to the communities we serve.
Quality and respect. These are the words Pacific Medical Centers (PacMed) employees live and work by. PacMed is a private, not-for-profit, primary and integrated multispecialty health care network with 10 outpatient clinics across the Puget Sound region and more than 175 primary and specialty care providers. Affiliated with the Providence Health & Services system, PacMed provides patient-focused health care — and even same-day appointments — to patients in King, Snohomish and Pierce counties. We provide immediate access to cutting-edge technology, first-class facilities and board-certified specialists, many of whom have been listed as among “Seattle’s Best Doctors.”
Pacific Medical Centers, PacMed, and their Affiliates' (collectively “PacMed”) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. PacMed does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Schedule: On Call
Job Category: Case Management
Req ID: 322106