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

Stanford Health Care•Palo Alto, CA

7d•$96 - $111

About The Position

Stanford Health Care is hiring a licensed nursing professional to coordinate care and discharge planning for an assigned caseload of inpatients. The Case Manager coordinates admissions and discharges, performs utilization review, and promotes appropriate use of resources, compliance with external review requirements, and effective delivery of care. The role serves as a consultant and resource to clinical teams, service lines, departments, patients, and families, and contributes to program development and quality improvement initiatives. This is not a direct-patient-care role; the Case Manager ensures that necessary services and treatments are delivered in a clinically and financially efficient manner. The position supports timely discharge, efficient resource use, expected patient outcomes, collaborative practice, continuity across the care continuum, and performance and quality improvement. The Case Manager manages transitions between clinical services and discharge, coordinates plans for patients with complex needs, reviews admissions and levels of care, monitors length of stay, and collaborates with physicians and interdisciplinary teams. The role also supports payer reimbursement by reviewing and communicating clinical and psychosocial information, and may lead administrative or clinical support staff assisting with a patient caseload. The position requires a bachelor's degree and a California Registered Nurse (CA-RN) license. A master's degree is preferred, along with three years of progressively responsible and directly related work experience. The listed base pay scale generally starts at $96.35–$111.14 per hour; the final salary depends on factors including internal equity, experience, education, specialty, and training.

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 access to the appropriate level of care, providers, setting, and services, and 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 during admission, referral, transfer, or discharge.
Ability to remain knowledgeable about available treatments and services.
Ability to resolve conflicts or negotiate to achieve positive results 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, including responsibility and accountability for practice outcomes.
Knowledge of evaluation and assessment techniques.
Knowledge of financial processes for private and public funding sources for health care services and procedures.
Knowledge of hospital operations, organization, systems, and procedures, and laws and regulations pertaining to hospital operations in California.
Knowledge of medical terminology and related levels of care and treatment.
Knowledge of the full 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.
Knowledge of variables that affect patient health care processes and outcomes.
Adopt and execute Stanford Health Care's C-I-CARE standards for interactions with patients, families, and colleagues.

Nice To Haves

Master's degree.

Responsibilities

Coordinate each assigned patient's transition through the health care system and transfer accountability to the appropriate person when the patient enters another clinical service or is discharged.
Coordinate and facilitate timely discharge plans for patients with complex needs in collaboration with interdisciplinary team members, and arrange follow-up care as appropriate.
Conduct prospective, concurrent, and retrospective utilization reviews of inpatients for admission appropriateness, level of care, and length of stay.
Monitor length of stay and collaborate with physicians to ensure resource use is appropriate to the patient's covered benefits, clinical needs, 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 aggregate and individual patient variances and share findings with staff, physicians, and administration.
Educate and consult with patients, families, and hospital personnel about discharge planning, applicable regulatory requirements, case management, and 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; 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; perform patient assessments and develop plans of care when required.
Participate in quality improvement activities, identify opportunities to improve 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.
Apply Stanford Health Care's C-I-CARE standards and experience pillars in interactions with patients, families, and colleagues.