The RN Case Manager is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience. The RN Case Manager works in collaboration with the Physician, Medical Social Worker and bedside RN to assure the timely movement of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. Oversees the management of acute patient populations across the care continuum with the primary focus to provide coordinated, timely and integrated care. The RN Case Manager reports to either the Supervisor or Manager or Director of Care Coordination in each facility. The RN Case Manager has frequent contact with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources.
MINIMUM POSITION REQUIREMENTS:
BS in one of following: Nursing or Health related field. Master in nursing, case management or other health related field preferred.
National Certification in Case Management (i.e. ACM, ANA RN-BC Case Management) preferred.
Current California RN licensure required.
Minimum of three (3) years in acute medical/surgical/ED/ or critical care nursing area required. Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED/ or critical care nursing area may be considered for employment at director's discretion.
Previous Case Management experience preferred.
Experience utilizing electronic InterQual or other standardized criteria strongly preferred.
Previous leadership abilities preferred.
Excellent interpersonal communication and negotiation skills.
A broad knowledge base of health care delivery and case management within a managed care environment.
Comprehensive knowledge of Utilization Review, levels of care, and observation status
Some awareness of healthcare reimbursement systems: HMO, PPO, PPS,CMS preferred
Post-acute levels of care such as Home Health, Hospice, AIM, and Palliative Care. SNF, LTAC, B&C, Sub-acute, Acute rehab
General Knowledge of coding and DRG assignment process preferred.
Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.
Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
Demonstrates commitment to service excellence in all patient, family and employee interactions and in performing all job responsibilities.
Functions in a manner to promote quality patient care and assure a positive patient experience.
Excellent verbal and written communication skills.
Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
Intermediate computer skills.
Ability to promote teamwork and to effectively function in teams.
Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.