Case Manager II - Sharp Tri-City - FT - 8hr Day shift

About the role

The Case Manager II assumes responsibility for the coordination of services in order to maximize patient outcomes. Inherent in the position is assessment, evaluation, collaboration and coordination of patient care delivery systems and participation in appointed service line activities. Emphasis is on cost-effective and cost-efficient strategies which maximize quality care within the current health care environment for the identified patient population. The Case Manager II is responsible for the coordination of utilization management, discharge planning and other health care services/systems. The Case Manager II functions as a contact person, coordinator and facilitator for the patient, family, health care team members and claims/insurance personnel as necessary.

Responsibilities

• Maintains a safe, clean working environment, including unit based safety and infection control requirements.
• Conduct comprehensive assessments to identify patient needs and develop individualized discharge care plans.
• Responsible for the coordination of services in order to maximize patient outcomes.
• Assess, evaluate, collaborate and coordinate patient care delivery systems and participation in appointed service line activities.
• Responsible for the coordination of utilization management, discharge planning and other health care services/systems.
• Functions as a contact person and facilitator for the patient, family, health care team members and claims/insurance personnel as necessary.
• Act as a patient advocate, ensuring dignity and confidentiality.
• Demonstrate empathy and compassion for patient experience.
• Advocate for evidence-based practices in case management and utilization review.
• Maintain a safe, clean working environment, adhering to infection control and hospital policies.
• Comply with regulatory standards (e.g., The Joint Commission, OSHA).
• Identify and report safety concerns proactively.
• Ensures cost-effective and cost-efficient strategies which maximize quality care within the current health care environment for the identified patient populations.
• Accurately document assessments and patient interactions in the Electronic Health Record (EHR) according to Department Standards.
• Provide preceptorship and mentorship to New Graduate Nurses, New Hires, and students, supporting their professional development.
• Participate in continuing education and quality improvement initiatives.
• Serve as a resource for best practices within Case Management.
• Activate emergency response system during patient emergencies (e.g., Rapid Response Team (RRT) situations).

Requirements

• Bachelor's Degree in Nursing Or Associate's Degree in Nursing with 5 years’ experience as a Registered Nurse in case management in lieu of BSN.
• 2 Years experience as a Registered Nurse in case management or utilization management.
• California Registered Nurse (RN) - CA Board of Registered Nursing - REQUIRED.

Qualifications

• Accredited Case Manager (ACM) - American Case Management Association (ACMA) - PREFERRED.
• Certified Case Manager (CCM) - Commission for Case Manager Certification - PREFERRED.

Skills

• Knowledge of Prospective Payment System and The Joint Commission standards and regulatory requirements pertaining to Utilization Management and Discharge Planning.
• Proficient computer skills, including Word.
• Knowledge and understanding of various payer types.
• Experience with referral management system.
• Rapid decision-making skills and ability to pivot plans on short notice.