Case Manager (RN) - Relief B status (0.4 FTE), 08-hr, Day Shift

About the role

This is a Stanford Health Care job. A Brief Overview Case Managers are licensed nursing professionals responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients.

Responsibilities

• Cordination of Care — Complex case manager who manages each patient's transition through the system and transfers accountability to the appropriate person upon entry into another clinical service or discharge.
• Discharge Planning - Coordinates and facilitates timely implementation of discharge plans for assigned patients with complex needs in collaboration with other interdisciplinary team members; arranges follow up care as appropriate.
• Utilization Review – Review prospectively, concurrently and retrospectively, all inpatients for appropriateness of admission, level of care, and determines appropriate length to stay. Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs; plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration.
• Education/Consultation- Acts as an educational resource and provides consultation to patients and their families, hospital medical personnel regarding the discharge planning process and applicable regulatory requirements; educates the staff on case management; and provides specific information related to case types.
• Lead Work- May lead the work of administrative/clinical support staff responsible for assisting with case management for an assigned patient caseload.
• Other - Participates in department program planning, goal setting, systems development and process improvement; participates in department and hospital committees and task forces; develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines; prepares and maintains records as required; collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned.
• Patient Assessment / Plan of Care- Functions as a resource to and collaborates with physicians, social workers, nurses, and other interdisciplinary team members to assess, plan, and coordinate patient care needs and/or performs patient assessment and develops a plan of care to assure consistent, timely, and appropriate care is provided in a patient focused manner.
• Quality Improvement -- Participates in quality improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection; participates in clinical process improvement teams within the department, service lines, and hospital.
• Third-Party Reimbursement -- Collects, analyzes reports and reviews patient information with third-party payers to assure reimbursement for patient services/procedures. Communicates with review organizations / payers to provide requested clinical and psychosocial information to assure reimbursement.

Qualifications

• Bachelor's Degree from an accredited college or university required
• Master's Degree preferred
• Three (3) years of progressively responsible and directly related work experience required