Case Manager, Registered Nurse
About The Position
Coordinates utilization management, resource management, discharge planning, post-acute care referrals, and care facilitation. Oversees acute patient populations across the care continuum, with a focus on coordinated and integrated care to prevent unnecessary admissions and readmissions. Coordinates discharge planning and interventions for high-risk patients presenting to the Emergency Department. Promotes patient wellness, improved care outcomes, efficient use of health services, and minimized payment denials for patients with complex health needs. This is a per diem/casual, non-exempt position at CPMC-California Pacific Medical Center Van Ness. The schedule is days, with variable days of the week, 8-hour shifts, and rotating weekend requirements. The position is listed at $87.46–$118.34 per hour; pay may vary based on work location and candidate-related factors. Eligible positions include a comprehensive benefits package.
Requirements
- Bachelor’s degree in Nursing or Health Administration, or equivalent experience in lieu of the degree.
- California Registered Nurse (RN) license.
- At least three years of acute medical/surgical, Emergency Department, or critical care nursing experience; a Master’s in Nursing in Case Management may be considered in lieu of this experience at the director’s discretion.
- Experience conducting clinical assessments for patients with complex medical, emotional, and social needs.
- Experience using an electronic medical record system.
- Excellent interpersonal, verbal, and written communication and negotiation skills.
- Broad knowledge of healthcare delivery and case management in a managed care environment.
- Comprehensive knowledge of utilization review, levels of care, and observation status.
- Knowledge of post-acute care levels, including Home Health, Hospice, AIM, Palliative Care, SNF, LTAC, B&C, Sub-acute, and Acute Rehab.
- Ability to communicate effectively and promote cooperation and collaboration among patients, families, caretakers, physicians, nurses, and ancillary partners.
- Ability to work independently and exercise sound judgment.
- Strong time-management skills and ability to organize work amid high volume and changing priorities.
- Intermediate computer skills.
- Ability to promote teamwork and function effectively in teams.
- Ability to collaborate with internal and external constituents using customer-service skills that support an excellent patient experience.
- Commitment to service excellence and quality patient care.
Nice To Haves
- Master’s degree in Nursing, Case Management, or a related field.
- Certified Case Manager (CCM).
- Previous case management experience.
- Experience using InterQual or other standardized criteria.
- Experience and knowledge with MIDAS.
- Awareness of healthcare reimbursement systems, including HMO, PPO, PPS, and CMS.
- General knowledge of coding and the DRG assignment process.
Responsibilities
- Coordinate utilization management, resource management, discharge planning, post-acute care referrals, and care facilitation.
- Oversee acute patient populations across the care continuum and support coordinated, integrated care to prevent unnecessary admissions or readmissions.
- Coordinate discharge planning and interventions for high-risk patients presenting to the Emergency Department.
- Promote patient wellness, improved care outcomes, efficient utilization of health services, and minimized payment denials.
- Communicate and collaborate with patients, families, caretakers, physicians, nurses, and ancillary partners to support quality care and a positive patient experience.
- Work independently and exercise sound judgment in interactions with physicians, payers, patients, and families.
- Organize work effectively in a high-volume environment with rapidly changing priorities.
Benefits
- Comprehensive benefits package for eligible positions
