CCPN RN Inpatient Acute Case Management

About the role

Under the direction of the Senior VP of Medical Management, responsible for review, provide guidance and coordination for the Acute units of the Utilization Review Department. Evaluate inpatient medical records using criteria and facilitate discharge plans and needs. Interact with other departments, clinic personnel, and outside providers in a professional and friendly manner.

Responsibilities

• Evaluate inpatient medical records using criteria and facilitate discharge plans and needs.
• Interact with other departments, clinic personnel, and outside providers in a professional and friendly manner.
• Cover Acute care patients on a rotational schedule based on the needs of the department.
• Accepts responsibility for assigned patients in the acute setting.
• Perform initial patient interview to assess, identify, evaluate and plan a safe discharge.
• Interview to include: Activity level, POA or Contact person information, Durable Medical Equipment needed or utilized, Baseline functional status of all patients, Primary Caregiver at home, Social network or barriers to care, Advanced Directives (POA).
• Verify consulting physicians are contracted.
• Perform daily concurrent review on assigned patients.
• Assessment to include: Chart review for evaluation of appropriate level of care and document on tracking sheet including procedures and specialty consults, Identify barriers to treatment and/or delays report to Sr. VP of Medical Management, Proactively reach out to expedite procedures or consults, Facilitate patients’ progress through the continuum of care.
• Report aberrant bed days per policy.
• In person or telephonic sign-out of all hospitalized patients must be conducted daily with Sr. VP of Medical Management or designee.
• Electronic sign-out on all patients must be submitted by end of shift each day.
• Maintain communication with attending physician throughout the hospital stay to discuss procedures, consult patient progress, barriers to care and patient status regarding any utilization of hospital services or problems noted.
• Work with attending physician to identify discharge needs and identify any barrier to discharge.
• Facilitate discharge plans.
• Perform daily utilization review with Medical Director and Sr. V.P. of Medical Management or designee regarding status of all hospitalized patients.
• Be proactive with treatment options.
• Aggressively assist in information gathering to allow for continuity of care.
• Aid in patient problems as assigned by the Medical Director and Sr. VP of Medical Management.
• Proactively gather information to specialty and attending pertinent information to support transitions in levels of care.
• Educate patients and caregivers regarding Advance Directives.
• Strive for positive and professional relationship with providers, patients and families.
• Ensure a smooth transition of care after discharge.
• Initiate/participate in Code Red, Code White, and Code Blue situations.
• Requires effective communication with involved health care provider.
• Must have familiarity with the clinical structure of BFMC and the contracted health care services.
• Act in a proactive manner to the benefit of the patient regardless of setting.
• Communicate with attending physician regarding any utilization of hospital services or problems noted.
• Establish and maintain a functional familiarity with all contract services with which we deal.
• Evaluate each patient’s support system. This may include immediate family, extended family and close friends.
• Understand patient benefits and help establish expectations for service within those benefit limits.
• Aid in establishing decisions regarding resuscitation, durable power of attorney, and efforts to obtain Medi-Cal benefits when appropriate.
• Be available and willing to fill in as needed, case management schedule is subject to change if not yet posted based on the needs of the department.

Requirements

• Graduate from an accredited Registered Nursing program.
• Current California RN license.
• Current BLS certification.
• Minimum of two years clinical nursing experience.
• Minimum of one year utilization review experience.
• Ability to utilize electronic mail effectively.
• Valid CA Driver's license and current vehicle insurance.

Qualifications

• Must evaluate each patient’s support system.
• Must understand patient benefits and help establish expectations for service within those benefit limits.
• Must aid in establishing decisions regarding resuscitation, durable power of attorney, and efforts to obtain Medi-Cal benefits when appropriate.

Skills

• Effective communication with involved health care provider.
• Familiarity with the clinical structure of BFMC and the contracted health care services.
• Proactive manner to the benefit of the patient regardless of setting.

Benefits

Not specified.

Pay

The pay range for this position at commencement of employment is expected to be reasonably between $57.00 and $67.06. However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.

Schedule

At-will position.