Case Manager (RN) - Timely Discharge - 1.0 FTE, 08-hr, RotatingShift

1.0 FTE Full time, rotating 8-hour shifts, onsite in Palo Alto, California.

About the Role

Case Managers are licensed nursing professionals responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients. Major responsibilities include coordinating all facets of a patient's admission and discharge, performing utilization review activities, ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. Case Managers 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.

A hospital-based case management system aims to ensure the most appropriate use of services by patients, avoid duplication and misuse of medical services, control costs by reducing inefficient services, and improve the effectiveness of care delivery. Objectives include facilitating timely discharge, prompt and efficient use of resources, achievement of expected outcomes, collaborative practice, coordination of care across the continuum, and performance/quality improvement activities that lead to optimal patient outcomes.

Responsibilities

• Coordination of Care – Manage each patient's transition through the system and transfer accountability to the appropriate person upon entry into another clinical service or discharge.
• Discharge Planning – Coordinate and facilitate timely implementation of discharge plans for assigned patients with complex needs in collaboration with other interdisciplinary team members; arrange follow-up care as appropriate.
• Utilization Review – Review prospectively, concurrently, and retrospectively all inpatients for appropriateness of admission, level of care, and determine appropriate length of stay. Monitor patients' length of stay and collaborate with physicians to ensure resource utilization remains within covered benefits and aligns with the patient's clinical and psychosocial needs. Plan and implement strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes through multi-disciplinary meetings or rounds.
• Education/Consultation – Act as an educational resource and provide consultation to patients, families, and hospital medical personnel regarding the discharge planning process and applicable regulatory requirements. Educate staff on case management and provide specific information related to case types.
• Lead Work – May lead the work of administrative or clinical support staff responsible for assisting with case management for an assigned patient caseload.
• Patient Assessment / Plan of Care – Collaborate with physicians, social workers, nurses, and other interdisciplinary team members to assess, plan, and coordinate patient care needs. Perform patient assessments and develop plans of care to ensure consistent, timely, and appropriate care in a patient-focused manner.
• Quality Improvement – Participate in quality improvement activities by identifying opportunities for improvement in clinical outcomes, utilization of resources, and concurrent data collection. Engage in clinical process improvement teams within the department, service lines, and hospital.
• Third-Party Reimbursement – Collect, analyze, report, and review patient information with third-party payers to assure reimbursement for patient services and procedures. Communicate with review organizations or payers to provide requested clinical and psychosocial information to ensure reimbursement.
• Other Duties – Participate in department program planning, goal setting, systems development, and process improvement. Contribute to department and hospital committees and task forces. Develop and maintain documentation of findings, discharge arrangements, and actions taken according to departmental guidelines. Prepare and maintain records as required. Collect, analyze, and report data for utilization, quality improvement, compliance, and other areas as assigned.

Requirements

• 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).

Skills

• Ability to collect and record data, evaluate data and statistics, and maintain effective reporting systems.
• Ability to develop and perform patient assessment and plan of care.
• Ability to monitor and ensure the patient's access to the appropriate level of care, providers, and services to meet their needs; promote coordination and continuity in patient healthcare.
• Ability to provide age-appropriate assessments, interpretation of data, and delivery of interventions.
• Ability to provide appropriate patient care and clinical information during admissions, referrals, transfers, or discharges.
• Ability to remain knowledgeable regarding available treatments and services.
• Ability to resolve conflicts and/or negotiate with others to achieve positive results; establish and maintain effective interpersonal relationships.
• Ability to understand, interpret, and apply complex federal and state hospital compliance laws, rules, regulations, and guidelines.
• Ability to work effectively with individuals at all levels of the organization.
• Knowledge of available patient services and treatments.
• Knowledge of current theories, principles, practices, standards, emerging technologies, techniques, and approaches in the nursing profession and the healthcare system, including responsibility and accountability for the outcome of practice.
• Knowledge of evaluation and assessment techniques.
• Knowledge of financial processes of various private and public funding sources for healthcare services and procedures.
• Knowledge of hospital operations, organization, systems, procedures, and laws/regulations pertaining to the operation of hospitals in California.
• Knowledge of medical terminology and related levels of care and treatment.
• Knowledge of the full continuum of care available to patients, interrelationships of care components, and their effective integration.
• Knowledge of the models of case management, including principles and practices of discharge planning, utilization review, and quality assurance/improvement.
• Knowledge of the variables that affect the processes and outcomes of patient healthcare.

Licenses and Certifications

• CA-RN (Registered Nurse) required.

Pay

Generally starting at $96.35 - $111.14 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.