Case Manager (RN) - Timely Discharge - 1.0 FTE, 8-HR, Day Shift

This is a full-time, onsite position at Stanford Health Care 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, and compliance with external review agencies' requirements. Case Managers act as consultants to clinical teams 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, and improve the effectiveness of care delivery. Objectives include facilitating timely discharge, efficient use of resources, achievement of expected outcomes, collaborative practice, coordination of care across the continuum, and performance/quality improvement activities.

Responsibilities

• Coordination of Care: Manage each patient's transition through the system and transfer accountability appropriately upon entry into another clinical service or discharge.
• Discharge Planning: Coordinate and facilitate timely implementation of discharge plans for patients with complex needs in collaboration with 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 length of stay. Monitor patients' length of stay and collaborate with physicians to ensure resource utilization aligns with clinical and psychosocial needs.
• Education/Consultation: Act as an educational resource for patients, families, and hospital personnel regarding discharge planning and regulatory requirements. Educate staff on case management and provide specific information related to case types.
• Lead Work: May lead administrative or clinical support staff responsible for assisting with case management for an assigned patient caseload.
• Patient Assessment/Plan of Care: Collaborate with interdisciplinary teams to assess, plan, and coordinate patient care needs. Perform patient assessments and develop plans of care to ensure consistent, timely, and appropriate care.
• Quality Improvement: Participate in quality improvement activities by identifying opportunities for improvement in clinical outcomes, resource utilization, and concurrent data collection. Engage in clinical process improvement teams.
• Third-Party Reimbursement: Collect, analyze, report, and review patient information with third-party payers to ensure reimbursement for services. Communicate with review organizations to provide clinical and psychosocial information.
• Other Duties: Participate in department program planning, goal setting, systems development, and process improvement. Develop and maintain documentation of findings and discharge arrangements. Prepare and maintain records as required.

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.

Skills

• Ability to collect, record, and evaluate data and statistics; maintain effective reporting systems.
• Ability to develop and perform patient assessments and plans of care.
• Ability to monitor and ensure patients' access to appropriate levels of care, providers, and services.
• Ability to provide age-appropriate assessments, interpretation of data, and delivery of interventions.
• Ability to provide appropriate patient care and clinical information during transitions (admission, referral, transfer, or discharge).
• Knowledge of available treatments and services.
• Ability to resolve conflicts and negotiate effectively to achieve positive results; establish and maintain interpersonal relationships.
• Ability to understand, interpret, and apply complex federal and state hospital compliance laws, rules, and regulations.
• Ability to work effectively with individuals at all levels of the organization.
• Knowledge of available patient services, treatments, and the full continuum of care.
• Knowledge of current theories, principles, practices, standards, and emerging technologies in nursing and the healthcare system.
• Knowledge of evaluation and assessment techniques.
• Knowledge of financial processes for private and public funding sources for healthcare services.
• Knowledge of hospital operations, systems, procedures, and relevant laws and regulations in California.
• Knowledge of medical terminology and related levels of care and treatment.
• Knowledge of models of case management, including discharge planning, utilization review, and quality assurance/improvement.

Qualifications

• CA-RN (Registered Nurse) license 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 internal equity, experience, education, specialty, and training.