Case Manager, RN

Salinas Valley Health•Salinas, CA

15h

About The Position

The Case Manager, RN performs utilization review and discharge planning for assigned patients under the direction of the Director and/or Manager of Case Management. The role analyzes medical records for medical necessity, level of care, and appropriate use of hospital services; assesses patient and family needs; identifies resources; develops discharge plans; and supports continuity of care. The case manager refers cases that do not meet utilization screening criteria to physician reviewers, monitors length of stay, collaborates with hospital personnel on care delivery, screens patients for discharge needs, facilitates discharge teaching, and evaluates discharge planning and follow-up resources. For NICU patients, the role helps ensure infants have appropriate discharge information and follow-up with a primary care physician, and arranges specialized high-risk infant follow-up when appropriate. Duties include assessing high-risk follow-up eligibility, advising parents or guardians about the process, arranging specialty appointments and physician-ordered durable medical equipment, facilitating home health nursing visits, and making qualifying referrals to CCS. Under the Director of Case Management, the role develops and implements neonatal discharge-planning standards and maintains expertise through literature review and participation in conferences. For pediatric patients, the role ensures appropriate discharge information, communication with primary care physicians and community agencies, and referrals to appropriate CCS programs, Special Care Centers, and Regional Centers. It ensures culturally and linguistically appropriate written discharge instructions are provided to parents, guardians, or primary caregivers, covering diagnosis, medications, follow-up appointments, and home medical treatment instructions, with copies provided to the primary physician. The role also teaches caregivers about the child’s medical needs and required technology, and coordinates multidisciplinary discharge-planning conferences. Other duties may be assigned.

Requirements

Associate of Science in Nursing (ASN) required.
Current California RN license.
Current BLS/Healthcare Provider status according to American Heart Association standards.
Three years of acute medical-surgical nursing experience.
At least one year of utilization review, case management, or discharge-planning experience in an acute-care hospital, 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.
Assess patient and family 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 follow-up care resources and evaluate the effectiveness of discharge planning.
For NICU infants, ensure appropriate discharge information and primary care follow-up, and arrange specialized high-risk infant follow-up when appropriate.
Determine whether NICU infants meet high-risk follow-up criteria and advise parents or guardians about the process.
Arrange specialty clinic appointments, physician-ordered durable medical equipment, and opportunities for home health nursing visits after NICU discharge.
Refer qualifying infants to CCS and instruct parents or guardians on the referral process.
Develop and implement neonatal-unit discharge-planning standards of care under the direction of the Director of Case Management.
Maintain neonatal discharge-planning expertise by reviewing current literature and attending and/or presenting at conferences.
For pediatric patients, ensure appropriate discharge information and communication with primary care physicians, community agencies, and relevant CCS programs, Special Care Centers, and Regional Centers.
Ensure culturally and linguistically appropriate written discharge instructions are provided to the parent, legal guardian, or primary caregiver, and copies are provided to the primary physician.
Teach caregivers about the medical needs of pediatric patients, including use of technology needed to support post-discharge care.
Coordinate multidisciplinary infant, pediatric, and/or adolescent healthcare team members in discharge-planning conferences.
Perform other duties as assigned.