Case Manager

Loma Linda•Murrieta, CA

2d•Onsite

About The Position

The Case Manager serves as a key member of the patient care delivery team and works efficiently in a fast-paced environment and utilizes clinical expertise, discretion and independent judgment in performing the nursing process (assessment, care planning, intervention, evaluation) within a patient-centered care professional practice model (Duffy's Quality-Caring Model) as it relates to case management functions. Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria (medical necessity) are met for level of care provided and is documented from admission through discharge. Practices in a collaborative healthcare environment to oversee implementation of a well-thought-out interdisciplinary plan of care with an individualized discharge plan that is comprehensive and best meets the continuing healthcare needs of the patient. Reevaluates plan of care and ensures continued appropriateness based on the patients changing needs and condition. Represents nursing as an empowered profession and readily embraces new knowledge, innovations and improvements. Exhibits positivity and serves as an instrumental change agent and expertly minimizes resistance to change in the workforce, clinical practice and operational setting. Engages in opportunities to directly or indirectly influence decision-making for clinical practice by supporting and participating in committees, task forces and staff meetings. Performs other duties as needed.

Requirements

Bachelor of Science degree in nursing (BSN) required.
Minimum two years of hospital nursing experience required.
Basic knowledge of case and utilization management practice and methodologies and state and federal healthcare regulations and accreditation required.
Able to speak, read and write legibly in English.
Able to use computer, printer and software programs necessary to the position, e.g., Microsoft Office Suite, Outlook, electronic medical record, electronic event reporting program.
Able to relate and communicate positively, effectively and exhibit professional behavior at all times.
Able to work calmly and respond courteously when under pressure.
Able to be assertive and consistent in following policies.
Able to teach, and collaborate.
Able to accept direction.
Able to think critically.
Able to work independently with minimal supervision.
Able to perform basic math and statistical functions.
Able to manage multiple assignments effectively.
Able to organize and prioritize workload.
Able to problem solve.
Able to recall information with accuracy.
Able to pay close attention to detail.
Able to hear sufficiently for general conversation in person and on the telephone.
Able to identify and distinguish various sounds associated with the work place.
Able to see adequately to read computer screens, medical records, and written documents necessary to position.
Active and unrestricted California Registered Nurse (RN) license required.
Current Basic Life Support (BLS) certification issued by the American Heart Association required.

Nice To Haves

Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred.
Spanish language proficiency preferred.
Nationally recognized certification in Utilization Management or Case Management preferred.

Responsibilities

Serves as a key member of the patient care delivery team.
Utilizes clinical expertise, discretion, and independent judgment in performing the nursing process (assessment, care planning, intervention, evaluation) within a patient-centered care professional practice model.
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices.
Ensures medical appropriateness criteria (medical necessity) are met for level of care provided and is documented from admission through discharge.
Practices in a collaborative healthcare environment to oversee implementation of a well-thought-out interdisciplinary plan of care with an individualized discharge plan.
Reevaluates plan of care and ensures continued appropriateness based on the patients changing needs and condition.
Represents nursing as an empowered profession and readily embraces new knowledge, innovations and improvements.
Exhibits positivity and serves as an instrumental change agent and expertly minimizes resistance to change.
Engages in opportunities to directly or indirectly influence decision-making for clinical practice by supporting and participating in committees, task forces and staff meetings.
Performs other duties as needed.