Registered Nurse (RN) / Case Manager

Sante Health•Fresno, CA

27d•$48 - $69•Onsite

About The Position

Sante Health System is looking for organized, personable Registered Nurses (RNs) in the Fresno, CA area to apply to be a full-time Case Manager. This nursing/case management role is responsible for coordinating medical management functions. If you are ready to bring your skills to a healthcare organization that will value you, keep reading! Our Registered Nurse (RN) / Case Manager enjoys competitive compensation, generous benefits, and a great work environment. If you are ready to build a satisfying career with an established and respected healthcare organization in the Central Valley, apply today with our initial 3-minute, mobile-friendly application!

Requirements

Graduate of an accredited school of nursing
Minimum of one year of professional nursing experience in a clinic or hospital
Possess a State Registered RN license
Knowledge of general clerical office procedures
Skill in operating a computer and basic office equipment
Ability to handle large volumes of work expediently and accurately
Ability to organize and prioritize work
Ability to sort and file materials correctly by alphabetic or numeric systems
Ability to work effectively with others
Ability to communicate clearly
Knowledge of professional nursing theory and practice and evaluate patient care
Knowledge of organizational policies, regulations and procedures to administer patient care
Knowledge of medical equipment and instruments to administer patient care
Knowledge of common safety hazards and precautions to establish a safe work environment
Skill in applying and modifying the principles, methods and techniques of professional nursing to provide on-going patient care
Skill in identifying problems and recommending solutions
Skill in preparing and maintaining records, writing reports, and responding to correspondence
Skill in developing and maintaining department quality assurance
Skill in establishing and maintaining effective working relationships with patients, medical staff and the public
Ability to maintain quality control standards
Ability to react calmly and effectively in emergency situations
Ability to interpret, adapt and apply guidelines and procedures
Exceptional verbal and written communication skills
Compassionate and able to easily build relationships
Team player
Excellent organizational skills

Nice To Haves

5 years of case management experience preferred
CPR certification is preferred

Responsibilities

Conduct concurrent and ongoing reviews of patient documentation in the medical record.
Perform utilization management based on applicable patient care protocols, length of stay and physician documentation using InterQual guidelines.
Inpatient reviews telephonically from various hospital case managers as well as reviewing faxed cases. Daily reviewing of inpatient records via EPIC and EMR in the computer system.
Assess physical and psychosocial patient and family needs necessary for case management.
Work directly with insurance companies regarding verification of benefits and eligibility, for medical necessity.
Manage cases involving severe illness or injuries requiring unique treatments and a high degree of medical expertise.
Participate in multidisciplinary plan of care as necessary including identification of care outcomes and barriers.
Assist in developing an appropriate hospital discharge plan and authorizing home health, skilled nursing facilities, sub-acute facilities, rehabilitation centers and durable medical equipment needs for the patient upon discharge.
Follow discharged patients with case management consisting of but not limited to home phone calls, calls to patient's physician and others facilitating his outpatient care.
Maintain current knowledge of Medicare, Medi-Cal and all health plans contracted with Santé.
Provide assistance and education to staff and physicians in resolving questions or problems involving patient treatment plans, medical staff relations, interpersonal conflicts and patient care providers. Developing and maintaining effective working relationships with those contacted in the course of work.
Generate statistical reports and case summaries. Maintain patient demographics. Maintain a list of patient problems and diagnosis including problems not currently being managed for reference. Track patient's medications and lab results. Manage short-term and long-term goals and challenges. Track case interventions and case outcomes. Schedule calls and appointments. Maintain call notes and case notes. Maintain integrity of data security with HIPAA laws.
Input authorizations into the AS400 and the MG 400 systems on a daily basis.
Case review of prior authorization requests for Medical Director on a daily basis using medical justification and member's insurance coverage for authorizations.
Work closely with the senior products to deliver quality skilled nursing care at contracted facilities within the framework of financial efficiency. Monitoring patient's rehabilitation progresses enabling them to return to their prior living arrangements. Being in contact with the acute hospital's case managers to input authorizations for ambulance transfers from the acute to the skilled nursing facilities or to their homes for end of life care thru hospice.
Attend required meetings and participate in committees as requested.
Participate in professional development and maintain professional affiliations.
Maintain strictest patient confidentiality.
In the spirit of teamwork, employees are expected to follow any other job-related instructions and to perform any other job-related duties as requested.