Responsibilities The Case Manager is responsible for utilizing advanced practice nursing skills in the assessment, education, and coordination of care for an identified group of patients. Collaborates and consults with the multi-disciplinary team, including but not limited to Physicians, Nursing, Ancillary, Professional, Technical, and other clinical and/or department team members along with patients and families to ensure safe and effective coordination of care. Assesses, coordinates, develops and implements individualized care plans utilizing evidence based tools for risk stratification to ensure delivery of safe, high quality, efficient, and cost-effective care. Performs Utilization Review functions using standardized practice tools to guide billing and level of care practices. Assures the delivery of concurrent and post-hospital care through initiation of referrals, coordination of resource utilization, and evaluation of post-acute care services. Effectively manage the post-acute referral process through the continuum of care to ensure safe discharge. Participate in performance improvement projects/processes and other duties as assigned. Identify and implement comprehensive DC plan for high risk patient utilizing risk stratification
Qualifications Experience: BSN, CA RN License Required Minimum of three years of acute hospital experience; or the equivalent of education and experience. Recent experience in case management, utilization management, or discharge planning Team leading or management experience.
Basic working knowledge of a large University teaching hospital; its purpose and functions. Skills: Ability to effectively communicate to physician/staff the medical necessity/appropriateness/level of care criteria that is necessary for acute care hospitalization. Ability to effectively communicate to the payer the medical necessity/appropriateness/level of care criteria that is necessary for acute care hospitalization. Skill in setting priorities that accurately reflect the relative importance of job responsibilities. Skill in abstracting and interpreting medical information from patient records. Working knowledge of laws, rules, and regulations regarding utilization review and discharge planning functions of government programs such Medicare, Medi-Cal, and CCS. Clinical experience sufficient to understand and communicate medical diagnosis and courses of treatment to professional and non-professional personnel. Ability to develop an individualized case management plan that addresses physical, vocational, psychosocial, financial, and educational needs. Basic computer skills. Self-directed, assertive and creative in problem solving, systems planning and patient care management in a high volume work environment. Demonstrates resourcefulness, effective written and oral communication, diplomacy, organizational, and analytical skills
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Associated topics: asn, bsn, care unit, domiciliary, infusion, maternal, nurse clinical, registered nurse, tcu, unit