Case Manager (RN) - Inpatient - 1.0 FTE, 8-hr, Day Shift

Stanford Health Care•Palo Alto, CA

14d•$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 admission and discharge processes, perform utilization reviews, assess the timeliness and appropriate use of services, and help ensure efficient resource use, service delivery, and compliance with external review requirements. Case Managers consult with clinical teams, service lines, and other departments on patient assessment and care, and participate in program development and quality improvement initiatives. The role applies guidelines and collaborates with multidisciplinary teams to influence and direct the delivery and quality of patient care. The hospital-based case management system aims to support appropriate use of services, avoid duplication and misuse, control costs, improve care delivery, facilitate timely discharge, achieve expected outcomes, coordinate care across the continuum, and support performance and quality improvement. This position is not intended to provide direct patient care; instead, the Case Manager ensures that required services and treatments are accomplished in a financially and clinically efficient manner. The role covers all Case Manager classifications within the organization. All Case Managers must meet the essential functions and qualifications. Locations are Stanford Health Care in Palo Alto and Redwood City. The position is listed as 1.0 FTE, 8-hour day shift.

Requirements

Bachelor's degree from an accredited college or university.
Three years of progressively responsible and directly related work experience.
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 the appropriate level of care, providers, setting, and services, and promote coordination and continuity of health 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 state 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 of professional responsibility and accountability for practice outcomes.
Knowledge of evaluation and assessment techniques.
Knowledge of financial processes of private and public funding sources for health care services and procedures.
Knowledge of hospital operations, organization, systems, procedures, and laws and regulations pertaining to California hospitals.
Knowledge of medical terminology and related levels of care and treatment.
Knowledge of the continuum of care, interrelationships 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 health care processes and outcomes.

Nice To Haves

Master's degree preferred.

Responsibilities

Manage each assigned 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, level of care, and length of stay.
Monitor length of stay and collaborate with physicians to ensure resource utilization is within covered benefits and appropriate to the patient's clinical and psychosocial needs.
Plan and implement strategies through multidisciplinary meetings or rounds to reduce length of stay and resource consumption and achieve positive outcomes; analyze individual and aggregate variances and share findings with staff, physicians, and administration.
Provide education and consultation to 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.
Develop and maintain documentation of findings, discharge arrangements, and actions taken; maintain required records and 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 improvement opportunities involving 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; provide requested clinical and psychosocial information to review organizations and payers.