RN - Case Manager - CMC - AS Utilization Management - Part 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 comprehensive patient care.
• Coordinates care with other healthcare providers and agencies to ensure seamless transitions between hospitalization and community-based care.
• Collaborates with the social worker and palliative care resources to support patient and family needs during hospitalization and beyond.
• Manages patient care and discharge planning to optimize resource utilization and ensure timely transitions to appropriate settings.
• Ensures compliance with Medicare and Medi-Cal guidelines and benefit resources relevant to hospitalization and transition planning.
• Provides education to patients and families regarding their health conditions, treatment options, and self-care strategies.
• Monitors patient progress and adjusts care plans as necessary to achieve optimal outcomes.
• Works collaboratively with the multidisciplinary team to address patient needs and improve overall care quality.

Requirements

• Bachelor's Degree from an accredited school of nursing.
• 3 years of nursing experience in medical/surgical settings.
• Preferred 3 years of nursing experience in critical care settings.
• Preferred 2 years of care coordination/case management experience.
• RN license from the California Board of Nursing.
• BLS certification from the American Heart Association.
• ACM or CCM certification (strongly 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 their impact on 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, Allscripts, InterQual, and Microsoft Outlook.

Benefits

No specific benefits are mentioned in the job description.

Pay

The pay range for this position is $89.23 - $121.58 per hour. Offered 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.

Schedule

Work Schedule: Wed-Sat
Work Shift: 08:00 - 16:30
No Waive (United States of America)