Case Manager (RN)

Sonoma Valley Hospital•Sonoma, CA

3d•$60 - $82

About The Position

The Case Manager leads care coordination across hospital levels of care. The role completes patient assessments and transition-of-care planning that reflects the wishes and needs of patients and their families, and assists physicians and finance teams with resource utilization management using medical necessity criteria.

Requirements

Graduate of an accredited RN program.
At least 2 years of clinical patient care experience on a medical-surgical unit, specialty unit, or current experience working in case management.
Licensed RN in the State of California.
Certification in Case Management or Utilization Review at hire, or within 3 years of hire if the candidate has no case management experience.
Good written and verbal communication skills.
Ability to manage priorities and workflow.
Versatility, flexibility, and willingness to work enthusiastically with constantly changing priorities.
Ability to deal effectively with diverse individuals at all organizational levels.
Good judgment and ability to make timely, sound decisions.
Proficiency with computers and electronic forms of communication.

Responsibilities

Complete medical necessity criteria for inpatient and outpatient visits, document when patient status is not supported in the database, and report discrepancies during weekday morning huddles.
Complete assessments and discharge plans for inpatients.
Provide consultation for outpatient and observation stays when requested, and assist with discharge planning as needed.
Build provider networks and community resources and provide updates to the clinical team.
Assist with case management for preoperative preparation and discharge planning for inpatient or outpatient surgeries, particularly the Total Joint Program, as able.
Lead morning huddles focused on patient status, expected length of stay, and tentative discharge plans.
Conduct InterQual utilization reviews for patient admission criteria.
Report updates about changes in patient status during morning huddles.
Role-model organizational values, apply patient engagement strategies, and document information on patient whiteboards, including what matters to the patient.
Coordinate with nursing on My Plan educational goals before discharge.
Conduct patient assessment interviews to determine social determinants of health and discharge disposition, and base the discharge plan of care on information gathered.
Complete follow-up calls for high-risk patients as time allows.
Assist with requests for clinical information for medical necessity insurance reviews and arrange peer-to-peer calls when an appeal is warranted.