RN Case Manager- Per Diem

Summary of Position:

The RN Case Manager provides individual patient care coordination throughout the continuum.  Healthcare services are coordinated on behalf of the patient to promote care delivery in the appropriate level of care which will optimize clinical outcomes and customer service.  This position is responsible for facilitating and expediting care delivered to patients during their entire episode and coordinating discharge planning. This process requires the case manager to have direct contact with the patient, the patient’s family, the patient’s physicians and appropriate health care team members to ensure care coordination. The RN Case Manager completes utilization review on inpatients, observation patients and Short surgical stay patients when necessary.  The RN case manager assures that patients are admitted to the correct service. Services are provided based on the ages of the population served; Newborn through Geriatric - 65 years or older and in collaboration with the multidisciplinary care team. 

Qualifications

Education:

• Completion of an accredited Nursing program

• Bachelor's degree preferred.

Experience: 

• 3 years’ experience in the last 10 years in an acute hospital setting 

• Recent experience as an acute hospital or managed care case manager preferred.

• Strong computer skills required; database management experience preferred 

• In compliance with patient safety standards, must be able to effectively communicate in English; Bilingual abilities preferred.

• Utilization review experience preferred 

Knowledge/Skills/Abilities:

• Utilization review skills

• Care coordination and discharge planning skills

Certifications/Licensure:

• Current California RN license or ability to obtain prior to hire date

• Certified Case Manager (CCM ) preferred

• Current CPR/BLS certification by the American Heart Association required

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

• While performing the duties of this job, the employee is frequently required to walk, stand, sit, and talk or hear. 

• The employee is occasionally required to use hands to finger, handle, feel or operate objects, tools, or controls; and reach with hands and arms.

• The employee is occasionally required to climb or balance; stoop, kneel, crouch, or crawl.

• Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.

• Lifts, positions, pushes and/or transfer patients.

• The employee must occasionally lift and/or move up to 50 pounds.

Working Conditions 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Routine Hospital/Healthcare & Office/Administrative conditions.

• Contact with patients and guests under a wide variety of circumstances.

• Regularly exposed to the risk of bloodborne diseases.

• Exposure to infections and contagious disease.

• Exposed to hazardous anesthetic agents, body fluids and waste.

• Subject to hazards of flammable and explosive gases.

• Subject to varying and unpredictable situations, including the handling of emergency or crisis situations.

• Subject to pressure due to irregular hours, frequent interruptions and stressful situations due to multiple demands.

• Occasional travel to various health system locations. 

Essential Functions

1. Provides consistently exceptional care at all times.

2. Performs case management assessments on assigned patients within organizational timeframes:

Psychosocial – Family Support, Living Situation, Financial Status, payor source, prior DME provider, readmissions, cultural & spiritual values, mental Status – orientation, ability to care for self, Coping Mechanisms, food and housing insecurity and transportation to healthcare appointments. 

Determines the presence of any barriers to a safe and effective transition from an acute inpatient to a lower level of care. 

3. Performs utilization review(s) within organizational timeframes:

Accurately evaluates necessity for observation, short surgical stay or inpatient, admission, and continued stay using InterQual criteria.  

4. Completes the PASRR in a timely fashion.

5. Communicates timely and professionally with payers/outside reviewers regarding treatment plans, authorization and other issues. 

a. Develops a discharge plan based on the assessed needs of the patient and family in collaboration with the multidisciplinary team:

Collaborates with the physician on appropriate levels of care based on clinical needs and utilization criteria

Collaborates with community agencies and services

Makes timely referrals to social services when complex social service issues are identified

Coordinates timely discharges and transfers to appropriate levels of care

Communicates the discharge care plan to patient, family and health care professional; communicates any patient or family concerns to the care team

6. Ensures that patient/family education and support is provided to assist with understanding, accept and follow through with medical recommendations.

7. Integrates and manages established clinical guidelines, pathways, and protocols. When available, to enhance clinical effectiveness and clinical resource management.

8. Maintains knowledge and understanding of Medicare/Medicaid, managed care, other payer requirements and benefit limits.

9. Develops and maintains knowledge and understanding of hospital and community resources and facilitates use of most appropriate level of care to conserve patient, hospital and payer resources.

10. Serves as a resource to physicians regarding discharge planning, medical record documentation and issues that may affect resource utilization and reimbursement.

11. Monitors overall quality and customer services to the patient and the patient’s family.  Initiates appropriate collaboration and follow-up in response to identified issues.

12. The staff member can demonstrate knowledge and skills necessary to provide services appropriate to the age of the patients served. The individual demonstrates knowledge of the principles of growth and development over the lifespan and possesses the ability to identify each patient’s age-specific needs. 

13. Orients, instructs and trains assigned personnel to Case Management Department functions.

14. Demonstrates a working knowledge of regulatory and licensing standards and ensures that practice is compliant with standards.

15. Performs other related duties as assigned or requested.

16. Keeps updated on department policies and procedures.

17. Responds to the needs of the department by performing other duties, as necessary.