Population Health RN Inpatient Case Manager - NBMC (Full Time, Day)

NorthBay Health•Fairfield, CA

2d•$82 - $100•Hybrid

About The Position

The Population Health RN Inpatient Case Manager provides complex case management to diverse, high-risk capitated populations. The role coordinates care and services for members who need help navigating the healthcare system, supporting delivery of appropriate care and services at the right place and time. This work uses resources across the continuum of care and is conducted in collaboration with members, caregivers, medical-home providers, and other healthcare providers. The position uses a population-health approach to identify groups, improve member engagement, coordinate care delivery, and support better clinical outcomes. The position also assists the inpatient case management department as needed. The case manager identifies high-risk patients through referrals and reporting, assesses their clinical, psychosocial, financial, and support needs, and develops individualized care plans. The role educates and advocates for patients and families, coordinates providers and resources, manages referrals, and supports transitions between care settings. For inpatient cases, the position collaborates with physicians, Social Services, and the interdisciplinary team on care plans, patient pathways, discharge planning, and transitions to the next appropriate level of care. The case manager remains involved until the patient reaches planned functional-health goals, is discharged, or case management transfers to outpatient services. The position also contributes to department quality monitoring and improvement, evaluates case-management effectiveness and outcomes, and communicates performance-improvement strategies to the UM Manager and Director of Care Management as appropriate. Work is performed in accordance with established policies and procedures and NorthBay Health’s values. The position works an eight-hour shift on scheduled days based on business need and may be approved for hybrid remote work.

Requirements

Graduation from an accredited nursing school or college.
Bachelor of Science in Nursing (BSN) required.
Current California State RN license required.
Obtain Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification within two years of starting the position.
At least two years of relevant clinical experience.
At least one year of case-management experience; equivalent case-management education and/or experience will be considered.
Knowledge of personal computers and experience entering and retrieving data; MS Office Suite, specifically word processing, and/or good keyboard skills.
Ability to communicate effectively with patients, physicians, healthcare personnel, supervisory staff, and peers.
Ability to organize, prioritize, and manage assignments efficiently with minimal oversight and direction.
Willingness to research, learn, and obtain knowledge relevant to the position.
Professional and courteous demeanor, with the ability to work independently and collaboratively while maintaining positive relationships.
Ability to use critical thinking and sound clinical judgment and assessment skills.
Knowledge of NCQA, DHS, CMS, JCAHO, and EMTALA standards and federal and state regulations.
Knowledge of acute care, home care, subacute care, long-term care, hospice interventions, rehabilitation options, and community resources and requirements.
Knowledge of Milliman and InterQual medical-necessity guidelines.
Expert knowledge of CPT and HCPC codes and related guidelines.
Expert knowledge of ICE guidelines governing TAT, claims, and the denial process.
Knowledge of current healthcare standards and trends, best practices, management tools, and related resources and literature.
Knowledge of capitation and managed-care legislation.
Knowledge of CMSA Standards of Practice.
Adherence to established policies and procedures and attendance and punctuality expectations.
Ability to meet the physical demands of the role, including regular walking, stooping, bending, twisting, periods of sitting and standing, and computer keyboarding.

Nice To Haves

Master’s degree or other master’s-level preparation in nursing or a health-related field preferred.

Responsibilities

Identify high-risk patients by reviewing electronic health record referrals and other referral or departmental reporting sources.
Assess members’ needs and develop specific care plans addressing identified objectives, barriers, and goals.
Identify patients’ physical, behavioral, and social-support strengths and needs, including their engagement with providers.
Follow up with patients and providers on healthcare needs and coordinate resources or multidisciplinary support to address concerns.
Facilitate and manage referrals from referral specialists, providers, and care-management staff to ensure identified needs and red flags are addressed.
Provide individual health-education consultations and support health awareness for individuals, groups, and organizations.
Implement and oversee care plans and provide patient education in accordance with established policies and procedures.
Identify at-risk individuals, apply clinical guidelines, gather and evaluate medical, psychosocial, and financial information, and advocate for patients and families throughout their episodes of care.
Maintain availability to patients and families, facilitate communication among providers, monitor services, and meet directly with patients and families when appropriate.
Collaborate with patients, families, physicians, and interdisciplinary teams to develop and revise individualized comprehensive care plans.
Involve patients and their support systems in decision-making and use processes to assess understanding, acceptance, readiness to change, and ability to sustain health behavior changes.
Apply teaching and learning theories to help patients and families address the physical and emotional effects of body changes and chronic illness.
Document and communicate with providers and care-team members to minimize fragmented care and coordinate transitions, typically from hospital to home or community facilities.
Use problem-solving and conflict-resolution skills to support consistent quality care.
Participate in department quality monitoring and improvement, including quality audits, training, and assigned projects.
Evaluate case-management effectiveness in relation to patient outcomes, fiscal parameters, customer satisfaction, and system operations; communicate performance-improvement strategies to the UM Manager and Director of Care Management as appropriate.
Manage patients’ care through healthcare systems and collaborate with physicians and other providers on changes to care plans.
Develop comprehensive care plans with physicians, Social Services, and the interdisciplinary team; track patient pathways through DRG identification and assignment.
Communicate the anticipated discharge date to patients, families, physicians, and staff; reassess patients throughout their hospital stay and develop alternative discharge plans as needed.
Coordinate transition to the next appropriate level of care, involving outpatient case-management services or other resources when appropriate.
Remain involved until hospital discharge or transfer of the case-management function to outpatient services.
Perform other duties as assigned to meet the needs of the population managed.

Benefits

Medical insurance
Dental insurance
Vision insurance
Life insurance
Disability coverage
Long-term care coverage
Paid time off, including vacation, sick leave, holidays, and bereavement
403(b) retirement plan with employer match
Education reimbursement for eligible roles
Professional development and training programs
Employee Assistance Program
Wellness programs
Recognition programs
Shift differentials
Market-based compensation review and increases, subject to approval and organizational performance