Case Manager (RN) - Inpatient - 1.0 FTE, 08-hr, Day Shift

Stanford Health Care•Stanford, CA

53d•$96 - $111•Onsite

About The Position

Case Managers are licensed nursing professionals responsible for coordinating continuum-of-care and discharge-planning activities for a caseload of assigned patients. They coordinate admissions and discharges, conduct utilization reviews to assess timely and appropriate use of services, and help ensure effective resource use, service delivery, and compliance with external review requirements. They consult with clinical teams, service lines, and other departments on patient assessment and care, and participate in program development and quality improvement. By applying guidelines and collaborating with multidisciplinary teams, Case Managers influence the delivery and quality of patient care. The hospital-based case management system aims to ensure appropriate use of services, avoid duplication or misuse, control costs by reducing inefficient services, and improve care-delivery effectiveness. Its objectives include timely discharge, efficient resource use, achievement of expected outcomes, collaborative practice, coordination across the continuum of care, and quality improvement leading to optimal patient outcomes. The role is not intended to provide direct patient care; instead, Case Managers ensure that assigned patients receive required medical services and treatments in a financially and clinically efficient manner. The position also includes patient assessment and care planning, discharge coordination, utilization review, consultation and education, reimbursement coordination, documentation, and participation in departmental and hospital improvement activities. Case Managers may lead administrative or clinical support staff assisting with case management for an assigned caseload.

Requirements

Bachelor's degree from an accredited college or university.
Three years of progressively responsible and directly related work experience.
Current California Registered Nurse (CA-RN) license.
Ability to collect and record data, evaluate data and statistics, and maintain effective reporting systems.
Ability to develop and perform patient assessments and plans of care.
Ability to monitor and ensure patient access to appropriate levels of care, providers, settings, and services, and to promote coordination and continuity of care.
Ability to provide age-appropriate assessments, interpret data, and deliver interventions.
Ability to provide appropriate patient-care and clinical information when patients are admitted, referred, transferred, or discharged.
Ability to remain knowledgeable about available treatments and services.
Ability to resolve conflicts or negotiate to achieve positive results and establish and maintain effective interpersonal relationships.
Ability to understand, interpret, and apply complex federal and California hospital compliance laws, rules, regulations, and guidelines.
Ability to work effectively with individuals at all organizational levels.
Knowledge of available patient services and treatments.
Knowledge of current nursing and health care theories, principles, practices, standards, emerging technologies, techniques, and approaches, and accountability for practice outcomes.
Knowledge of evaluation and assessment techniques.
Knowledge of financial processes of public and private funding sources for health care services and procedures.
Knowledge of hospital operations, organization, systems, procedures, and laws and regulations pertaining to hospitals in California.
Knowledge of medical terminology and related levels of care and treatment.
Knowledge of the continuum of care, relationships among care components, and their effective integration.
Knowledge of case management models, including discharge planning, utilization review, and quality assurance and improvement principles and practices.
Knowledge of variables that affect patient-care processes and outcomes.
Commitment to Stanford Health Care's C-I-CARE standards for patient- and family-centered interactions.

Nice To Haves

Master's degree preferred.

Responsibilities

Coordinate each patient's transition through the system and transfer accountability to the appropriate person when the patient enters another clinical service or is discharged.
Coordinate and facilitate timely implementation of discharge plans for assigned patients with complex needs, collaborating with interdisciplinary team members and arranging follow-up care as appropriate.
Review inpatient admissions prospectively, concurrently, and retrospectively for appropriateness of admission and level of care, and determine appropriate length of stay.
Monitor length of stay and collaborate with physicians to ensure resource use is within covered benefits and appropriate to patients' clinical and psychosocial needs.
Plan and implement strategies through multidisciplinary meetings or rounds to reduce length of stay and resource consumption and achieve positive patient outcomes.
Analyze and address aggregate and individual patient variances, and share findings with staff, physicians, and administration.
Educate and consult with patients, families, and hospital medical personnel about discharge planning and applicable regulatory requirements; educate staff on case management and provide information related to specific case types.
May lead administrative or clinical support staff assisting with case management for an assigned patient caseload.
Participate in department program planning, goal setting, systems development, process improvement, committees, and task forces.
Document findings, discharge arrangements, and actions taken according to departmental guidelines, and prepare and maintain required records.
Collect, analyze, and report data for utilization, quality improvement, compliance, and other assigned areas.
Collaborate with physicians, social workers, nurses, and other interdisciplinary team members to assess, plan, and coordinate patient care needs, and/or perform patient assessments and develop plans of care.
Participate in quality improvement activities, identify opportunities related to clinical outcomes and resource utilization, collect concurrent data, and participate in clinical process improvement teams.
Collect, analyze, report, and review patient information with third-party payers to support reimbursement for patient services and procedures.
Communicate with review organizations and payers, providing requested clinical and psychosocial information to support reimbursement.
Adopt and execute Stanford Health Care's C-I-CARE standards and experience pillars in interactions with patients, families, and colleagues.