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Your next career move matters. We invite you to explore open positions at Trios Health, which is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® and creating places where employees want to work. Whether you’re an experienced professional or just beginning your career, you’ll find opportunities to use your skills and expertise. Looking for nursing career opportunities? Please visit here.

Case Management - Case Manager

Kennewick, Washington

Req ID CASEM028917 Post Date Jan. 02, 2025 CategoryManagement and Supervisors FacilityTrios Health
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*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 

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