CCSC RN Case Manager

Duties and Responsibilities

• Assesses and evaluates care provided to CEI members in non-CEI settings.
• Develops and evaluates appropriate treatment plans in conjunction with provider.
• Affirms appropriate, timely review and authorization for hospital or SNF stay.
• Acts as CEI single point of contact and liaison for hospital during business hours.
• Reviews clinical information and collaborates with internal and external physicians and other providers for optimal and timely disposition.
• Communicates frequently with CEI physician and IDT as needed to assure and execute optimal discharge and continuity of care plan.
• Develops collaborative, productive relationships with hospital and SNF health care providers to achieve optimal participant care and outcomes across the continuum.
• Knows about contracts and CEI benefit coverage. Identifies appropriate level of care for SNF placement, provides guidance for IDT.
• Collaborates with CEI physician to oversee care of CEI participants at SNF's.
• Maintains and documents participants' care according to established skilled care guidelines.
• Aids in the development, review, and revision of departmental policy and procedures which support positive outcomes and organizational objectives.
• Open to best practice model suggestions. Offers input and complies with department standards of care and practice as well as quality improvement activities.
• Investigates participant concerns as identified and offers satisfactory resolution regarding case management role.
• Consistently complies with organizational Code of Conduct by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state, and local laws and regulations, accreditation and license requirements.
• Models ethical behavior; adheres to organizational policies and guidelines; maintains confidences; admits mistakes; conducts work with honesty; shows consistency in words and actions and follows through on commitments.
• Demonstrates openness to creative and innovative approaches to providing service.
• Checks for new hospital admissions and ED visits via Direct Line Tele-Response fax transmission.
• Recording ED notifications and emailing messages to Clinic IDT.
• Locating contracted SNF, obtaining physician approval/authorization for participants who require short term placement.
• Requests hospital documentation for hospital stays and ED visits are reviewed by the provider.
• Ensures status updates are transmitted via email to all relevant parties as they occur for any participant going to or being discharged from the ED, hospital, and/or SNF.

Qualifications

• Bachelor of Science in Nursing (BSN) from an accredited school of nursing required.
• Certified Case Manager (CCM) preferred.
• Current California Nursing RN license required.
• CPR certificate required.
• 3-5 years of Case Management experience required.
• PACE work experience preferred.
• Understanding of Nurse Practice Act and all other local, state, and federal regulations.
• Demonstrated strong interpersonal communication skills.
• Experience working with electronic medical records and intermediate/advanced computer skills (Microsoft Office Suite) required.
• Ability to perform duties in heavy workload, fluctuating environment.