RN Case Manager- Per Diem

Barton Healthcare System•South Lake Tahoe, CA

10h

About The Position

The RN Case Manager provides individual patient care coordination throughout the continuum of care, coordinating services to promote delivery at the appropriate level of care and optimize clinical outcomes and customer service. The position facilitates and expedites care throughout each patient episode and coordinates discharge planning through direct contact with patients, families, physicians, and appropriate healthcare team members. The RN Case Manager performs utilization review for inpatients, observation patients, and short surgical stay patients when necessary, and ensures patients are admitted to the correct service. Services are provided to patients from newborn through geriatric age (65 years or older), in collaboration with the multidisciplinary care team. The role assesses patients’ psychosocial and care needs, identifies barriers to safe transitions, evaluates medical necessity using InterQual criteria, and develops and coordinates discharge plans. The RN Case Manager communicates with payers and outside reviewers, supports patient and family education, applies clinical guidelines and protocols, and maintains knowledge of payer requirements and available hospital and community resources. The position also serves as a physician resource, monitors quality and customer service, trains assigned personnel, and ensures compliance with regulatory and licensing standards.

Requirements

Completion of an accredited nursing program.
Three years of experience in the last 10 years in an acute hospital setting.
Strong computer skills.
Ability to effectively communicate in English, in compliance with patient safety standards.
Current California RN license or ability to obtain it before the hire date.
Current CPR/BLS certification from the American Heart Association.
Utilization review skills.
Care coordination and discharge planning skills.

Nice To Haves

Bachelor’s degree preferred.
Recent experience as an acute hospital or managed care case manager preferred.
Database management experience preferred.
Bilingual abilities preferred.
Utilization review experience preferred.
Certified Case Manager (CCM) preferred.

Responsibilities

Provide consistently exceptional care.
Complete case management assessments within organizational timeframes, including assessment of family support, living situation, financial status, payer source, prior durable medical equipment provider, readmissions, cultural and spiritual values, mental status, ability to care for oneself, coping mechanisms, food and housing insecurity, and transportation to healthcare appointments.
Identify barriers to safe and effective transitions from acute inpatient care to a lower level of care.
Complete utilization reviews within organizational timeframes and evaluate the necessity of observation, short surgical stay, inpatient admission, and continued stay using InterQual criteria.
Complete PASRR in a timely manner.
Communicate professionally and promptly with payers and outside reviewers regarding treatment plans, authorizations, and other issues.
Develop discharge plans based on patient and family needs in collaboration with the multidisciplinary team.
Collaborate with physicians on appropriate levels of care based on clinical needs and utilization criteria.
Collaborate with community agencies and services, and make timely social services referrals when complex social service issues are identified.
Coordinate timely discharges and transfers to appropriate levels of care.
Communicate discharge care plans to patients, families, and healthcare professionals, and relay patient or family concerns to the care team.
Ensure patient and family education and support to aid understanding and follow-through with medical recommendations.
Integrate and manage established clinical guidelines, pathways, and protocols when available to enhance clinical effectiveness and resource management.
Maintain knowledge of Medicare, Medicaid, managed care, other payer requirements, and benefit limits.
Maintain knowledge of hospital and community resources and facilitate use of the most appropriate level of care to conserve patient, hospital, and payer resources.
Serve as a resource to physicians regarding discharge planning, medical record documentation, and issues affecting resource utilization and reimbursement.
Monitor overall quality and customer service for patients and families, and initiate collaboration and follow-up in response to identified issues.
Demonstrate knowledge and skills appropriate to the ages served, including principles of growth and development and age-specific patient needs.
Orient, instruct, and train assigned personnel on Case Management Department functions.
Maintain working knowledge of regulatory and licensing standards and ensure compliant practice.
Keep updated on department policies and procedures.
Perform other related duties as assigned or requested, including duties needed to respond to department needs.