Registered Nurse Case Manager - Case Management - Full Time - 10-hour shifts - Days

Washington Hospital•Fremont, CA

53d•$90 - $122

About The Position

The Registered Nurse Case Manager is a member of the multidisciplinary health care team who facilitates patient movement through the continuum of care and back into the community. The case manager supports the physician and interdisciplinary team in facilitating patient care, with the objectives of enhancing clinical outcomes and patient satisfaction, managing the cost of care, and providing timely and accurate information to payors. The role makes utilization management and alternative-treatment decisions that reflect cost effectiveness and interfaces with internal departments, external departments, and agencies. It integrates and coordinates utilization management, care facilitation, and discharge planning. The case manager also helps drive change by identifying areas where performance improvement is needed. Other duties may be assigned as required.

Requirements

California Registered Nurse License.
BLS Certification.
Bachelor of Science in Nursing.
Current knowledge of reimbursement requirements, level of care, and clinical criteria.
Basic computer skills and knowledge of basic computer software programs.
Effective interpersonal and communication skills.
Flexibility and ability to adapt to changing priorities.
Good customer relations.
Ability to prioritize assignments and effective time-management skills.
Detail oriented, flexible, and committed to patient advocacy.
Skills in planning, organizing, and managing.
Excellent verbal and written communication skills.
Understanding of legal and regulatory issues affecting care delivery and reimbursement, including HIPAA, EMTALA, The Joint Commission, and Centers for Medicare and Medicaid Services (CMS).
Understanding of the CMS Conditions of Participation.

Nice To Haves

Two years of acute care experience as a Registered Nurse.
One year of recent experience in Case Management.
Case Management Certification.

Responsibilities

Facilitate patient movement through the continuum of care and back into the community.
Support physicians and the interdisciplinary team in facilitating patient care and enhancing clinical outcomes and patient satisfaction.
Manage the cost of care and provide timely and accurate information to payors.
Make utilization management and alternative-treatment decisions that reflect cost effectiveness.
Interface with internal departments, external departments, and agencies.
Integrate and coordinate utilization management, care facilitation, and discharge planning functions.
Identify areas where performance improvement is needed.
Perform other duties as required.
Adhere to hospital, divisional, and unit-based policies and procedures.
Practice within the scope of the California Nurse Practice Act in all aspects of patient care, promoting safe practice and reducing risk.