Case Manager Continuing Care Coord RN

Job Summary

Captures and coordinates care for patients in defined geriatric or other patient populations, developing and implementing a comprehensive, multi-disciplinary approach to manage health conditions, resources, and protocols.

About the Role

Works collaboratively with the multidisciplinary team to provide continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations for outside services.

Responsibilities

• Evaluates and develops baseline medical and psychosocial evaluations and individualized patient care/treatment plans in conjunction with primary care and specialist physicians.
• Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
• Develops and implements guidelines for care that may require coordination across systems of multiple providers/services.
• Coordinates care/services with utilization and/or quality reviewers and monitors level and quality of care.
• Coordinates interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
• Makes referrals to appropriate community services and outside providers.
• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
• Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment, hospitalization or referral to support services or placement.
• Arranges and monitors follow-up appointments. Coordinates repatriation of patients and monitors their quality of care.
• Develops and collects data; trends utilization of health care resources.
• Produces population based reports on outcomes specific to defined patient populations.
• Participates with healthcare team/providers in actualizing outcomes by planning, evaluating and implementing decisions and strategies to achieve predetermined cost, clinical, quality, utilization and service outcomes.
• Develops and maintains case management policies and procedures.
• Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
• Acts as liaison for outside agencies, non-plan facilities, and outside providers.
• Participates in committees, teams or other work projects/duties as assigned.

Requirements

• Two (2) years clinical experience as an RN in an acute care setting required.
• Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of utilization review/management, discharge planning or case management.
• Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
• Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills required.
• Computer literacy skills required.

Qualifications

• N/A

Skills

• Collaborative working style
• Interpersonal communication
• Problem-solving
• Regulatory knowledge
• Written and verbal communication
• Computer literacy

Benefits

N/A

Pay

$64.74 - $79.23 / hour

Schedule

Full-time