RN - Case Manager - AS Utilization Management - Walnut Creek - Full Time - 8 Hour - Days

John Muir Health•Walnut Creek, CA

10d•$87 - $119•Onsite

About The Position

The role of the inpatient case manager is one of patient advocate of appropriate utilization of resources. The inpatient case manager applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient’s health care needs through hospitalization and transition back to the community and does this in coordination with the interdisciplinary health team. The RN Case Manager is expected to function within the full scope of the nursing practice with specialized focus on care coordination, compliance, transition management, education, and utilization management. The RN CM, SW and care transitions team work in a collaborative approach, along with the individual patient and or their caregiver, to remove barriers for the safe transition of the patient.

Requirements

Associate's Degree Accredited School of Nursing or Degree/Diploma Obtained - Accredited School of Nursing Required
2 years Case Management or Equivalent Work Experience
RN Registered Nursing - California Board of Nursing Required
BLS Basic Life Support - American Heart Association Required
Strong written and verbal communication skills.
Effectively motivates teams.
Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning.
Working knowledge of common diagnoses and procedures and the impact this will have to patients/families and their ability to manage their care outside of the hospital.
Knowledge of individual and family development over the life span, and the influences of cultural and spiritual values in health care.
General knowledge of commercial coverage plans and usually covered benefits.
Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements such as ACOs, DRGs, Full Risk, etc.
Strong understanding of the criteria, rules and regulations around Inpatient, Observation and Outpatient levels of patient management.
Strong knowledge of geriatrics and the impact to health and function in the aged as well as a working knowledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc.
Clear understanding of the role of the inpatient Social Worker and Palliative Care Resources.
Ability to plan, organize, manage time and prioritize work in collaboration with others.
Ability to work independently and as a part of a multidisciplinary team.
Effective problem solving and conflict resolution skills.
Ability to work respectfully and creatively with clients of diverse functional abilities, social, economic, and cultural backgrounds to support both client autonomy and client safety.
Leadership skills to delegate and provide direction/guidance to staff and hold others accountable.
Able to learn and work in a variety of computer programs, including EPIC, InterQual, Allscripts, and Microsoft Outlook.

Nice To Haves

3 years Nursing - Medical/Surgical Preferred
3 years Nursing - Critical Care Preferred
ACM Accredited Case Manager - ACMA American Case Management Association or CCM Certified Case Manager - CCMC Commission for Case Manager Certification Strongly Preferred

Responsibilities

Patient advocate of appropriate utilization of resources.
Applies the process of assessment, planning, implementation, monitoring, evaluation and coordination of care to meet the patient’s health care needs through hospitalization and transition back to the community.
Functions within the full scope of the nursing practice with specialized focus on care coordination, compliance, transition management, education, and utilization management.
Works in a collaborative approach with the RN CM, SW and care transitions team, along with the individual patient and or their caregiver, to remove barriers for the safe transition of the patient.