Case Manager, RN

Salinas Valley Health•Salinas, CA

3d•$74 - $89

About The Position

Under the direction of the Director and/or Manager of Case Management, the Case Manager, RN performs utilization review and discharge planning for assigned patients. The role analyzes medical records for medical necessity, level of care, and appropriate use of hospital services; assists patients and families with discharge and after-care planning; assesses needs and identifies resources to support discharge requirements; and develops formal discharge plans. The Case Manager uses clinical knowledge and skills to support continuity of care, refers cases that do not meet utilization-screening criteria to physician reviewers, determines and monitors length of stay, and collaborates with hospital personnel to manage care delivery. The position screens patients for potential discharge needs, initiates discharge planning, facilitates discharge teaching, identifies follow-up care resources, and evaluates the effectiveness of discharge planning. For NICU patients, the role ensures appropriate discharge information and follow-up with a primary care physician, and arranges specialized high-risk infant follow-up when appropriate. It determines whether infants meet high-risk follow-up criteria, explains the process to parents or guardians, arranges specialty-clinic appointments, identifies discharge needs at admission, and arranges physician-ordered durable medical equipment. It also facilitates access to a home health agency nurse after discharge and refers qualifying infants to CCS, explaining the referral process to parents or guardians. Under the Director of Case Management, the role develops and implements neonatal-unit discharge-planning standards of care and maintains expertise by reviewing current literature and attending or presenting at conferences. For pediatric patients, the role ensures appropriate discharge information and communication with primary care physicians and community agencies, including CCS programs, CCS Special Care Centers, and Regional Centers. It ensures culturally and linguistically appropriate written discharge instructions are provided to the parent, legal guardian, or primary caregiver. Instructions include the diagnosis, medications, follow-up appointments, and home medical-treatment instructions, with copies provided to the primary physician. The Case Manager teaches caregivers about the medical needs of the infant, child, or adolescent, including use of technology needed for post-discharge care, and coordinates appropriate multidisciplinary healthcare team members in discharge-planning conferences. Other duties may be assigned.

Requirements

Associate of Science in Nursing (ASN) required.
Current California RN license required.
Current BLS/Healthcare Provider status meeting American Heart Association standards required.
Three years of acute medical-surgical nursing experience required.
At least one year of utilization review, case management, or discharge-planning experience in an acute-care hospital required, unless the posting specifies a training position.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred.

Responsibilities

Perform utilization review and discharge planning for assigned patients.
Analyze medical records for medical necessity, level of care, and appropriate utilization of hospital services.
Assist patients and families with discharge and after-care planning; assess needs, identify resources, and develop formal discharge plans.
Refer cases that do not meet utilization-screening criteria to physician reviewers.
Determine and monitor appropriate length of stay.
Collaborate with hospital personnel to manage care delivery.
Screen patients for potential discharge needs, initiate discharge planning, and facilitate discharge teaching.
Identify resources for follow-up care and evaluate discharge-planning effectiveness.
Ensure appropriate discharge information and follow-up arrangements for NICU infants, including primary care and, when appropriate, high-risk infant programs and specialty clinics.
Identify NICU discharge needs at admission and arrange physician-ordered durable medical equipment.
Ensure NICU infants have the opportunity for a home health agency nurse visit after discharge and refer qualifying infants to CCS.
Develop and implement neonatal-unit discharge-planning standards of care under the Director of Case Management.
Maintain neonatal discharge-planning expertise by reviewing literature and attending or presenting at conferences.
Ensure appropriate pediatric discharge information and communication with primary care physicians, community agencies, CCS programs, CCS Special Care Centers, and Regional Centers.
Ensure culturally and linguistically appropriate written discharge instructions are provided to caregivers and copies are given to the primary physician.
Teach caregivers about pediatric patients’ medical needs and the use of technology required for post-discharge care.
Coordinate multidisciplinary infant, pediatric, and/or adolescent healthcare team members in discharge-planning conferences.
Perform other duties as assigned.