RN - Case Manager - AS Utilization Management - Full Time - 8 Hour - Days

About the role

The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient’s health care needs through hospitalization and transition back to the community and does this in coordination with the interdisciplinary health team.

Responsibilities

• Applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient’s health care needs through hospitalization and transition back to the community.
• Functions within the full scope of the nursing practice with specialized focus on care coordination, compliance, transition management, education, and utilization management.
• Works effectively with the interdisciplinary health team to ensure appropriate utilization of resources.
• Coordinates care with other healthcare providers to ensure continuity of care.
• Ensures compliance with Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning.
• Provides education to patients and families regarding their health conditions and care plans.
• Manages patient transitions from hospital to home or other settings, ensuring smooth handoffs and follow-up care.
• Monitors and evaluates patient progress and adjusts care plans as necessary.
• Collaborates with the social worker and palliative care resources to support patient and family needs.

Requirements

• Master's Degree from an accredited school of nursing.
• 2 years of case management or equivalent work experience.
• 3 years of nursing experience, preferably in medical/surgical or critical care.
• ACCM or CCM certification preferred.

Skills

• Strong written and verbal communication skills.
• Effectively motivates teams.
• Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning.
• Working knowledge of common diagnoses and procedures and the impact this will have to patients/families and their ability to manage their care outside of the hospital.
• Specialized knowledge may be required for certain areas of practice.
• Knowledge of individual and family development over the life span, and the influences of cultural and spiritual values in health care.
• General knowledge of commercial coverage plans and usually covered benefits.
• Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements such as ACOs, DRGs, Full Risk, etc.
• Strong understanding of the criteria, rules and regulations around Inpatient, Observation and Outpatient levels of patient management.
• Strong knowledge of geriatrics and the impact to health and function in the aged as well as a working knowledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc.
• Clear understanding of the role of the inpatient Social Worker and Palliative Care Resources.
• Ability to plan, organize, manage time and prioritize work in collaboration with others.
• Ability to work independently and as a part of a multidisciplinary team.
• Effective problem solving and conflict resolution skills.
• Able to learn and work in a variety of computer programs, including EPIC, MIDAS, Allscripts, and Microsoft Outlook.

Fixed Schedule

Week 1: Sun-Wed
Week 2: Sun-Thurs
Work Shift: 08:00 - 16:30
No Waive (United States of America)

Pay Range

Offer amounts are based on demonstrated/relevant experience and/or licensure. Pay will be adjusted to the local market if hired outside of the Bay Area. Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting.

Scheduled Weekly Hours

36