The RN Case Manager is responsible for Care Coordination, Care Transitions, Discharge/Transition Planning and Utilization Management throughout the acute care patient experience. RN Case Manager coordinates care at admission and throughout the stay to ensure that patient outcomes are optimal, that evidence based care guidelines are followed and documented and the organization's costs are controlled. RN Case managers are both patients' advocate and the organization's stewards.The objective is to optimize the use of hospital resources by supporting timely patient movement to the appropriate level of care in a manner that supports patient/family. The RN Case Manager uses standardized criteria to evaluate admission, level of care and readiness for discharge. Discharge/Transition planning is provided for all patients to assess post discharge needs and to resolve transition care issues and barriers impeding progress towards goals. The RN Case Manager helps drive change by identifying areas where performance improvement is needed. The RN Case Manager works in collaboration with the Medical Social worker and interdisciplinary team to assure timeliness in care coordination and discharge planning throughout the hospital stay. Oversees the management of acute patient populations across the care continuum with primary focus to provide coordinated, timely and integrated care.
The Case Management Department at MPHS embraces the Scope of Services adopted by the American Case Management Association which states: "Case Management in Hospital and Health Care Systems is a collaborative practice model including patients, nurses, social workers, physicians and other practitioners, caregivers and the community. The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health access to care and appropriate utilization of resources, balanced with the patient's right to self-determination."
MINIMUM POSITION REQUIREMENTS:
Current California RN licensure required.
Basic Life Support Certification - BLS
Bachelor's degree in Nursing, required. Master in nursing, case management or other health related field preferred.
National Certification in Case Management (i.e. ACM, ANA RN-BC Case Management) upon hire or within 18 months of hire date for experienced case managers.
Newly trained case managers: National certification as noted above, within 24 months of hire.
Three or more year's clinical experience in acute medical/surgical or critical care practice area.
In lieu of 3 years clinical experience noted above, Masters degree in Case Management with clinical residency from acute medical/surgical practice area at a Sutter Health Affiliate.
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.