Case Manager (RN) - Inpatient - Relief A Status

• Coordination of Care — Complex case manager who manages each patient's transition through the system and transfers accountability to the appropriate person upon entry into another clinical service or discharge
• Discharge Planning - - Coordinates and facilitates timely implementation of discharge plans for assigned patients with complex needs in collaboration with other interdisciplinary team members
• arranges follow up care as appropriate
• Utilization Review – Review prospectively, concurrently and retrospectively, all inpatients for appropriateness of admission, level of care, and determines appropriate length to stay
• Monitors patients' length of stay and collaborates with physicians to ensure resource utilization remains within covered benefits and are appropriate in relationship to the patient's clinical and psychosocial needs
• plans and implements (through multi-disciplinary meetings or rounds) strategies to reduce length of stay, reduce resource consumption, and achieve positive patient outcomes, analyzes and addresses aggregate variances as well as variances for individual patients and shares this information with staff, physicians, and administration
• Education/Consultation- Acts as an educational resource and provides consultation to patients and their families, hospital medical personnel regarding the discharge planning process and applicable regulatory requirements
• educates the staff on case management
• and provides specific information related to case types
• Lead Work- May lead the work of administrative/clinical support staff responsible for assisting with case management for an assigned patient caseload
• Other - Participates in department program planning, goal setting, systems development and process improvement
• participates in department and hospital committees and task forces
• develops and maintains documentation of findings, discharge arrangements, and actions taken according to departmental guidelines
• prepares and maintains records as required
• collects, analyzes and reports on data for utilization, quality improvement, compliance, and other areas as assigned
• Patient Assessment / Plan of Care- Functions as a resource to and collaborates with physicians, social workers, nurses, and other interdisciplinary team members to assess, plan, and coordinate patient care needs and/or performs patient assessment and develops a plan of care to assure consistent, timely, and appropriate care is provided in a patient focused manner
• Quality Improvement -- Participates in quality improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection
• participates in clinical process improvement teams within the department, service lines, and hospital
• Third-Party Reimbursement -- Collects, analyzes reports and reviews patient information with third-party payers to assure reimbursement for patient services/procedures
• Communicates with review organizations / payers to provide requested clinical and psychosocial information to assure reimbursement

• Bachelor's Degree from an accredited college or university required
• Three (3) years of progressively responsible and directly related work experience required
• CA-RN (Registered Nurse) required
• Ability to collect and record data, evaluate data and statistics, and maintain effective reporting systems
• Ability to develop and perform patient assessment and plan of care
• Ability to monitor and assure the patient's access to the appropriate level of care
• the right health care providers
• and the correct setting and services to meet the patient's needs
• promote coordination and continuity in patient health care
• Ability to provide age-appropriate assessments, interpretation of data, and delivery of interventions
• Ability to provide appropriate patient care and clinical information when patients are admitted, referred, transferred, or discharged
• Ability to remain knowledgeable regarding available treatments and services
• Ability to resolve conflicts and/or negotiate with others to achieve positive results
• establish and maintain effective interpersonal relationships
• Ability to understand, interpret and apply complex federal and state hospital compliance laws, rules, regulations and guidelines
• Ability to work effectively with individuals at all levels of the organization
• Knowledge of available patient services and treatment
• Knowledge of current theories, principles, practices, standards, emerging technologies, techniques and approaches in the nursing profession, and the health care system, and the responsibility and accountability for the outcome of practice
• Knowledge of evaluation and assessment techniques
• Knowledge of financial processes of various private and public funding sources for health care services/procedures
• Knowledge of hospital operations, organization, systems and procedures and laws and regulations pertaining to the operation of hospitals in California
• Knowledge of medical terminology and related levels of care and treatment
• Knowledge of the full continuum of care available to patents, interrelationships of the care components, and their effective integration
• Knowledge of the models of case management, including the principles and practices of discharge planning, utilization review, and quality assurance/improvement
• Knowledge of the variables that affect the processes and outcomes of patient health care

Master's Degree preferred