Case Manager, RN - Per Diem

Salinas Valley Health•Salinas, CA

About The Position

Under the direction of the Director and/or Manager of Case Management, the Case Manager performs utilization review and discharge planning for assigned patients. The role analyzes medical records for medical necessity, level of care, and appropriate utilization of hospital services; helps patients and families plan discharge and aftercare; assesses needs, identifies resources, and develops formal discharge plans. The Case Manager supports continuity of care, refers cases that do not meet utilization screening criteria to physician reviewers, determines and monitors length of stay, collaborates with hospital personnel to manage care delivery, screens patients for potential discharge needs, facilitates discharge teaching, and evaluates discharge planning effectiveness. For NICU patients, the role ensures appropriate discharge information and follow-up arrangements, assesses high-risk follow-up eligibility, advises parents or guardians about the process, schedules specialty clinic appointments, identifies discharge needs at admission, and arranges physician-ordered durable medical equipment. The Case Manager helps ensure access to Home Health Agency nursing after discharge and refers eligible infants to CCS, instructing parents or guardians on the referral process. Under the Director of Case Management, the role develops and implements neonatal discharge-planning standards and maintains expertise through reviewing literature and attending or presenting at conferences. For pediatric patients, the role ensures appropriate discharge information and communication with primary care physicians, community agencies, and, when appropriate, CCS programs, Special Care Centers, and Regional Centers. It ensures written, culturally and linguistically appropriate discharge instructions are provided to the parent, legal guardian, or primary caregiver, covering diagnosis, medications, follow-up appointments, and home medical treatments, with copies provided to the primary physician. The role also ensures caregivers are taught the patient's medical needs and the use of necessary 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 meeting 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.
Assist patients and families with discharge and aftercare 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 and collaborate with hospital personnel to manage care delivery.
Screen patients for potential discharge needs, facilitate discharge teaching, identify follow-up resources, and evaluate discharge-planning effectiveness.
For NICU patients, ensure appropriate discharge information, primary care and specialized follow-up, and high-risk follow-up screening and guidance.
Arrange specialty clinic appointments and physician-ordered durable medical equipment for NICU infants, and support Home Health Agency and CCS referrals when appropriate.
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 literature and attending or presenting at conferences.
For pediatric patients, coordinate communication and referrals with primary care physicians, community agencies, CCS programs, Special Care Centers, and Regional Centers as appropriate.
Ensure caregivers receive culturally and linguistically appropriate written discharge instructions and teaching on medical needs, home treatments, and necessary technology; provide instruction copies to the primary physician.
Coordinate multidisciplinary infant, pediatric, and/or adolescent healthcare team members in discharge-planning conferences.
Perform other duties as assigned.