Case Manager

This is a Stanford Health Care Tri-Valley job.

About the role

Reviews each assigned case for appropriateness of admission and level of care. Acquires authorizations for non-elective admissions, continued stays, and post-acute hospital needs. Assesses patient/family needs for additional resources throughout the hospital stay and communicates identified needs and resources given to all appropriate team members.

Population served: Acute medical/surgical patients including neonate, pediatric, adolescent, young adult, middle-age, and geriatric.

Locations: Stanford Health Care Tri-Valley

Responsibilities

• Reviews medical information on all assigned patients and provides clinical justification of the admission using hospital/industry approved criteria within one working day, including identification of the appropriate level of care.
• Responsible for working collaboratively with all healthcare team members to develop and implement treatment plans that support the patient-centered plan of care for both individual patients and the service-line.
• Act as consultants to the clinical team, service lines, and other departments regarding patient assessment and patient care and participate in program development and quality improvement initiatives.
• Communicates accurately with Supervisor, Financial Counselors, Contract Dept., and/or Patient Accounting for pertinent account information or service needs.
• Coordinates with all facets of a patient's admission/discharge or outpatient visit/follow-up; performing utilization review activities, including review of patient charts for timeliness of services as well as appropriate utilization of services; and ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements.
• Consistently manages denials and facilitates the appeals process while keeping the physician and appropriate departments briefed on denial and progress of appeal.
• Coordinates activities of high risk patients related to inpatient care goals and 30 days after discharge by home visits and phone calls.
• Determines appropriate discharge options and identifies medical/psychological/social conditions that may require additional therapeutic support/treatment and communicates this to the staff contact at the higher level of care facility.
• Educates, coach and promote self-management skills and patient adherence to treatment plan by utilizing appropriate education methods based on the individualized patient needs, abilities, preferences and readiness to learn with respect to cultural, social, or ethical considerations.
• Actively participates in daily Patient Rounds. Attends staff meetings and serves on hospital wide committees.
• Employee must perform all duties and responsibilities in accordance with the C-I-CARE Standards of the Hospital. C-I-CARE is the foundation of Stanford Healthcare Tri – Valley patient-experience and represents a framework for patient-centered interactions.

Qualifications

Education

• Graduate from an accredited school of nursing
• BSN (Preferred)

Experience

• 2+ years to 3 years acute care nursing experience (Required)
• 2+ years to 3 years Utilization Review acute care hospital (Preferred)

Skills and Abilities

• Ability to work independently and function effectively as a member of an interdisciplinary team.
• Basic Computer skills required.
• Strong communication and interpersonal skills.
• Strong advocacy and problem-solving skills.
• Strong attention to detail.
• Knowledge of the principles of growth and development and the ability to assess and interpret data regarding a patient’s status to identify the patient’s needs and appropriate care.
• Knowledge of acute care in relation to safety, security and joint commission standards.

Licenses and Certifications

• Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure (Required)
• Current American Heart Association Certification for Basic Life Support for Healthcare Providers (Required)
• ACM or CCM - Certified Case Manager (Preferred)

Pay

Base Pay Scale: Generally starting at $70.57 - $95.29 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training.