Case Manager II - FT Days

Kindred Hospital San Francisco Bay Area is a 99-bed long-term acute care hospital offering the same in-depth care you would receive in a traditional hospital, but for an extended recovery period. We partner with your physician and offer 24-hour clinical care seven days a week to support your journey to wellness. For those who need special care, we offer a 10-bed ICU and two negative pressure rooms. Our location is about 7 miles east of Oakland International Airport, right off MacArthur Freeway (I-580).

About the Role

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery, and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation, and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, promotes continuity of care, and ensures cost effectiveness through the integration of case management, utilization review, and discharge planning functions.

Responsibilities

• Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Monitors all areas of patients’ stay for effective care coordination and efficient care facilitation.
• Remains current on reimbursement modalities, community resources, case management, psychosocial, and legal issues affecting patients and providers.
• Appropriately refers high-risk patients who would benefit from additional support.
• Serves as a patient advocate and enhances collaborative relationships to support informed decision-making by patients and families.
• Demonstrates knowledge of growth and development principles across the lifespan and applies skills for age-appropriate care.
• Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education, and identify post-hospital needs.
• Collaborates with clinical staff in developing and executing the plan of care and achieving goals.
• Coordinates with the interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others to plan care throughout the continuum.
• Conducts comprehensive, ongoing assessments to ensure timely and safe discharge planning.
• Develops and executes effective discharge plans using critical thinking.
• Coordinates and communicates efficiently with patients and families regarding discharge planning.
• Conducts medical necessity reviews for appropriate utilization of services from admission through discharge.
• Promotes effective and efficient utilization of clinical resources.
• Conducts timely and accurate clinical reviews, care collaboration, and coordination of continued stay authorization with payors.
• Adheres to the Company’s Code of Business Conduct, policies, procedures, and applicable federal/state laws and professional standards.
• Serves on Hospital and Division committees when requested.
• Performs other related duties as assigned.

Requirements

• Graduate of an accredited program required for RN; BSN preferred or MSW/BSW with licensure as required by state regulations.
• Healthcare professional licensure required as Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) / Licensed Social Worker (LSW) if required by state regulations.
• Certification in Case Management is a plus.
• Two years of experience in a healthcare setting preferred; prior experience in case management, utilization review, or discharge planning is preferred.
• Knowledge of government and non-government payor practices, regulations, standards, and reimbursement.
• Knowledge of Medicare benefits, insurance processes, and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Ability to demonstrate critical thinking, prioritization, and time management skills.
• Basic computer skills with proficiency in Microsoft Office, word-processing, and spreadsheet software.
• Excellent interpersonal, verbal, and written communication skills.
• Must read, write, and speak fluent English.
• Good and regular attendance is required.

Pay

$64.55–$81.87 per hour.

Benefits

ScionHealth offers a comprehensive benefits package for eligible employees, including:

• Medical, Dental, and Vision coverage
• 401(k) retirement plan
• Flexible Spending Account (FSA) / Health Savings Account (HSA)
• Life Insurance
• Paid Time Off
• Wellness programs