Providence Case Manager - RN Navigator in Kodiak, Alaska
Providence is calling a Case Manager/Registered Nurse (RN) Navigator (Utilization Review , Days , 1.0 FTE) to Providence Kodiak Medical Center in Kodiak, Alaska. We are a community of caregivers delivering every day on our Mission to provide compassionate care that is accessible for all - especially those who are poor and vulnerable.
In this position you will:
Partner with the healthcare team, community resources, liaisons, patient and families to provide timely coordinated admission and discharge planning that is appropriate based on patient needs.
Match patients with appropriate internal and external resources to meet their ongoing needs, and facilitates application(s) for programs and referrals for special needs for admission and discharge planning.
Assist in management of resources with informational and monitoring tool(s) that support access, confidentiality, and assessment, analysis of care and throughput, intervention, efficiencies, and quality of care.
Perform integrated initial and concurrent review to identify medical necessity and utilization issues.
Apply admission, continued stay/transfer, and discharge criteria to each patient’s case.
Interface with external review companies and consultants, using advocacy and negotiating skills that address medical necessity and appropriateness of inpatient/outpatient levels of care.
Provide case management for complex patients post-discharge for up to 90 days assuring successful reintegration in the community. Effectively utilizes tools that measure, monitor, and manage quality and stewardship of patient care resources. Act as a partner in identifying and achieving timely patient care needs with implementation of the plan of care that is appropriate, resourceful, and valuable.
Exhibit the necessary written skills for effective communication and documentation, including writing appeals. Assure the patient receives information on benefits, risks, costs, and treatment/ bed status alternatives.
Communicate with physicians at regular intervals throughout hospitalization and develops an effective working relationship to assist the physicians to maintain appropriate cost and desired patient outcomes.
Work within the community to develop understanding of community issues and partners with the team to facilitate patient and family transitions to home. Facilitate interdisciplinary patient care rounds and/or care conferences to review treatment goals, optimize resource utilization, provide family education, and identify post-hospital needs.
Participate in the development, implementation and maintenance of departmental policies and procedures in accordance with current Joint Commission, Federal, State and Municipal requirements to ensure safe and effective services in collaboration with Utilization Reviewer, finalized by the Case Management Manager or designee.
Correlate organizational data on length of stay, avoidable days, denial days, readmissions, admission referrals, and RAC denials with Utilization reviewer reporting to Case Management Manager.
Perform staff education related to utilization review, case management, and discharge planning in collaboration with utilization reviewer. Offer coverage for Utilization reviewer as necessary.
CUSTOMER SERVICE: Embrace the Providence Service Standards in all aspects of position. Present and conduct self in a professional manner. Provide support to coworkers and customers while demonstrating service excellence by building positive interpersonal relations to ensure productive and positive relationships are maximized. Develop a deep understanding of customer’s perspectives and needs and works to meet their expectations. Build a culture of true caring by behavior and interactions with others.
COMMUNICATION/TEAMWORK: Communicate in a compassionate and professional manner. Demonstrate professional interpersonal and verbal skills when communicating with other department and of the care delivery team to provide optimal continuity of care to patients and their families. Is able to communicate effectively with a wide variety of people from differing literacy levels, languages and cultures. Demonstrate commitment to teamwork and interacts harmoniously with others to ensure team success. Supports new orientees in learning department routines. Exhibit the ability to work independently, and as a team.
CRITICAL THINKING AND ORGANIZATION: Demonstrate effective priority setting and organization skills to promote departmental workflow and cost efficiency. Ensure smooth, efficient services and maximizes comfort and confidentiality for the patient. Anticipate potential obstacles and adjusts work assignments to prevent unnecessary delays. Recognize errors/problems and takes corrective action when necessary. Utilize available resources to recognize errors/problems and takes corrective action and assists with problem resolution.
QUALITY IMPROVEMENT: Support the quality control and quality assurance programs by supplying and/or developing indicators to measure, monitor, and report performance to other team members. Seek input from various customer groups to maintain quality. Report any performance improvement suggestions to the department leader.
PURCHASING: Ensure an effective purchasing process is maintained by requisitioning necessary products and supplies for personnel, determining necessary quality/quantity requirements, selecting suppliers according to current contracting, arranging for deliveries, following up on orders, dispensing of equipment and other items when necessary. Develops and/or maintains department records keeping system, regarding par levels of department supplies. Submit invoices for approval and processing in a timely manner.
EDUCATION/PROFESSIONAL DEVELOPMENT: Assist with responsibility for obtaining information and expanding job knowledge and competency that reflects current practice. Role models personal development and education. Evaluate own practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations.
PERSONNEL: Demonstrate knowledge and support of quality improvement goals. Participate in department, facility and organizational projects or committees as assigned.
Implement care/services that recognize age/diversity specific needs/issues of customers served.
Complete Competency Plan for assigned job and department.
Required qualifications for this position include:
Graduate of an accredited/approved school of Nursing.
Associate's Degree in Nursing
Licensed as a Registered Nurse (RN) in the State of Alaska
Basic Life Support (BLS) certification within 90 days of hire
Current Alaska driver’s license with a clean driving record and proof of current vehicle insurance
Compass training to be completed within 1 year from date of hire
3 years of clinical nursing experience
Prior experience with provider requirements for admissions transfers and discharges
Prior experience using Electronic Medical Records (EMR) such as EPIC
Preferred qualifications for this position include:
Case Management certification
1 year of experience as an RN in Utilization Management-review, Case Management and/or Discharge-planning experience
Experience with InterQual criteria, Medicare and Medicaid regulations
Prior experience using Microsoft Office Suite
About Kodiak Island Medical Center
Providence Kodiak Island Medical Center (PKIMC) provides comprehensive health care to residents and visitors of Kodiak Island. This critical access hospital features 25 acute care beds, including four birthing suites, one OB triage room, and two ICU beds. In addition, the Elder House, PKIMC’s long term care facility, has 22 beds.
PKIMC provides an extensive array of inpatient and outpatient services, including emergency department, surgery, laboratory services, maternity, general medicine, physical therapy, occupational therapy, respiratory therapy, sleep studies, specialty clinics, diagnostic imaging services and pharmacy and is staffed by a mix of primary care physicians, surgeons and specialists who provide family practice, internal medicine, obstetrics, radiology and general practice.
For more information regarding Providence Kodiak Island Medical Center, please click on the following link: http://providence-kodiakhealthcare.jobs/
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Req ID: 278051