Nurse, Care Management
2 months ago
Summary
SUMMARY: Responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients; develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, and identifies cost-effective protocols. Care Management provides Care Coordination, Compliance, Transition Coordination, and Utilization Management.
DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.
1. Coordinates all utilization review functions, including response to payor requests for concurrent and retrospective review information including Medicare and MediCal regulations/requirements, avoidable days and quality issues. Applies Medical necessity criteria to determine level of care.
2. Assures clinical interventions are appropriate for the admitting diagnosis and Level of Care that reflects the standard of care, as defined by the medical staff and the organization; identify inappropriate admit status based on identified criteria and ensures the patient is registered at the appropriate level of care. Utilizes McKesson Interqual® clinical guidelines; refers questionable cases to the CM Manager or physician advisor for determination.
3. Takes appropriate action when cases do not meet criteria. Escalates to the attending physician, and the Care Management physician advisor of any concurrent denials.Prepares case reports;documents treatment plan, progress notes and discharge summary related information as required by Medicare, MediCal, Title 22 and other mandated regulations according to Department standards.Reassesses the patient’s condition when changes occur and revises the care plan when appropriate.
4. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social work, and other healthcare providers and agencies. Completes an initial assessment within 24 hours of admission and documents findings in the electronic health record. Processes referrals and authorizations that adhere to federal, state and local insurance regulatory agencies and offer patient choice per regulation.
5. Identifies potential problems prevents and or resolves barriers to the discharge plan. Along with the social work team member
6. Mobilize resources to effect rapid and timely movement of the patient through system to achieve targeted discharge times established by AHS.
7. Identifies and mobilizes patients and family strengths to optimize use of healthcare and community resources. In coordination with patient and family wishes, guide/assist in securing needed post discharge services
8. Collaborates with Care Management teams (i.e. Care Transition team and CM teams at other facilities) for high risk patients for timely follow-up appointments and confirms prior to discharge that complex patients are appropriately linked to community services.
9. Provides community resource education and coaching, focusing on individual patient self-management principles. Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient.
10. Communicates with physicians and multidisciplinary health team members to provide continuity of care, supporting and maintaining the multidisciplinary team approach to ensure effective resource utilization and appropriate level of care.
11. Makes independent assessments and recommendations regarding course of action in complex situations.
12. Confirm all applicable department and regulatory targets for department performance process improvements are attained (e.g., re admissions, throughput, LOS).
MINIMUM QUALIFICATIONS:
Required Education: Associate Degree in Nursing
Preferred Education: Bachelor’s of Nursing
Preferred Education: Master’s in Nursing
Required Experience: Three years of acute care nursing
Preferred Experience : Medical/surgical or critical care experience; broad clinical background. Within the last 3 years, experience in Case Management in an acute setting or utilization review at a medical group or health plan.
Required Licenses/Certifications : Active licensure as a Registered Nurse in the State of California, Active BLS - Basic Life Support Certification issued by the American Heart Association; other advanced life support certifications may be required per unit/department specialty according to patient care policies; CPI -Crisis Prevention Intervention Training (required for all positions at John George Psychiatric Pavilion; and certain positions in the Emergency Department).
Preferred Licenses/Certifications: Certification in Case Management, CCMC or ACM. Bilingual Preferred.
Highland General HospitalHGH Care Coordination
Part Time
Day
Care Management
FTE: 0.5
-
Manager, Care Management
2 months ago
Oakland, CA, United States Alameda Health System Full timeSummary Alameda Health System offers outstanding benefits that include: 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: Alameda Health...
-
Manager, Care Management
2 months ago
Oakland, CA, United States Alameda Health System Full timeSummary Alameda Health System offers great benefits to our employees! 100% employer health plan for employees and their eligible dependents Unique benefit offerings that are partially or 100% employer paid Rich and varied retirement plans and the ability to participate in multiple plans. Generous paid time off plans Role Overview: The Manager of...
-
Travel Nurse RN Case Manager
2 weeks ago
Oakland, California, United States Nurse First Full timeNurse First is seeking a travel nurse RN Case Manager for a travel nursing opportunity in California.Job DetailsSpecialty: Case ManagementDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelNurse First Travel Agency is committed to providing travel nurses with the best experience possible. Our company's founder was a...
-
Care Management Specialist
2 weeks ago
Oakland, CA, United States Alameda Health System Full timeSummary SUMMARY: Assists in Care Management Team of social workers and nurses with functions such as but not limited to provide census reconciliation, administrative support for care coordination and discharge planning activities, working with the payors, accurate and critical information data entry and tracking, and report creation. DUTIES &...
-
Travel Nurse Case Manager
6 days ago
Oakland, California, United States TotalMed Case Management Staffing Full timeTotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a travel nursing job.Job DetailsSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment in California.TotalMed Case Management Staffing Job ID # Pay package is based on 8 hour shifts and 40 hours per week...
-
Nurse Manager
4 weeks ago
Oakland, California, United States Elder Care Alliance Full timeAbout This Career OpportunityWe are seeking a skilled and compassionate Nurse Manager to join our team at Elder Care Alliance. As a key member of our healthcare team, you will be responsible for providing exceptional care to our residents and ensuring the highest level of quality and safety in our skilled nursing setting.ResponsibilitiesAssess, plan, and...
-
Travel Nurse RN Case Manager
2 weeks ago
Oakland, California, United States TotalMed Case Management Staffing Full timeJob Title: Travel Nurse RN Case ManagerTotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a travel nursing job in a major California city.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment in California.TotalMed Case...
-
Travel Nurse RN Case Manager
1 month ago
Oakland, California, United States TotalMed Case Management Staffing Full timeJob Title: Travel Nurse RN Case ManagerTotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Oakland, California.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse...
-
Travel Nurse for Progressive Care Unit
1 week ago
Oakland, California, United States Nurse First Full timeNurse First is seeking a travel nurse for a PCU position in a dynamic healthcare environment.Job Description & Requirements~ Specialty: PCU - Progressive Care Unit~ Discipline: RN~ Shift: 12 hours, days~ Employment Type: TravelNurse First offers a competitive pay package based on 12 hour shifts and 36 hours per week, with a tax-free stipend amount to be...
-
Travel Nurse RN Case Manager
6 days ago
Oakland, California, United States TotalMed Case Management Staffing Full timeTotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a travel nursing job.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment.TotalMed Case Management Staffing Job ID #1653396. Pay package is based on 8 hour shifts and 40 hours...
-
Travel Nurse RN Case Manager
2 weeks ago
Oakland, California, United States TotalMed Case Management Staffing Full timeTotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a travel nursing job in California.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RN40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment in California.TotalMed Case Management Staffing...
-
Travel Nurse RN Case Manager
6 days ago
Oakland, California, United States TotalMed Case Management Staffing Full timeTotalMed Case Management Staffing is seeking a travel nurse RN Case Management professional for a travel nursing opportunity.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RN40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for a travel nursing assignment.TotalMed Case Management...
-
Nurse, Care Management
3 weeks ago
Oakland, United States Alameda Health System Full timeSummary SUMMARY: Responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients; develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, and identifies cost-effective protocols. Care Management provides Care Coordination,...
-
Travel Nurse RN Case Manager
2 weeks ago
Oakland, California, United States Nurse First Full timeJob SummaryNurse First is seeking a skilled travel nurse RN Case Manager to join our team.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelNurse First is committed to providing our travel nurses with the best experience possible. Our company's founder was a nurse first, and at our roots, we believe nurses need...
-
Nurse, Care Management
2 months ago
OAKLAND, United States Alameda Health System Full timeSummary SUMMARY: Responsible for coordinating continuum of care and discharge planning activities for a caseload of assigned patients; develops plans of care and discharge plans, monitors all clinical activities, makes recommendations for alternative levels of care, and identifies cost-effective protocols. Care Management provides Care Coordination,...
-
Travel Nurse Case Manager
6 days ago
Oakland, California, United States Travel Nurse Source Full timeAbout the PositionWe are seeking a qualified Case Management Registered Nurse (RN) to join our team at Travel Nurse Source. As a Case Manager RN, you will play a vital role in making a positive impact on patient care. Our client in Oakland, California, needs a Travel RN to work 8hr Days, 40hrs per week. This assignment starts on November 25th and lasts for...
-
Travel Nurse RN Case Manager
6 days ago
Oakland, California, United States TotalMed Case Management Staffing Full timeTotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a travel nursing job.Job DetailsSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment.TotalMed Case Management Staffing Job ID #1653396. Pay package is based on 8 hour shifts and 40 hours per week (subject...
-
Travel Nurse RN Case Manager
6 days ago
Oakland, California, United States TotalMed Case Management Staffing Full timeTotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a travel nursing job.Job DetailsSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment in California.TotalMed Case Management Staffing Job ID # Pay package is based on 8 hour shifts and 40 hours per week...
-
Oakland, California, United States Travel Nurse Source Full timeAbout the PositionCore Medical Group is seeking a qualified Case Manager RN to work in Oakland, California. The ideal candidate will have a strong background in case management and excellent communication skills. The position involves working with clients to develop and implement care plans, coordinating with healthcare teams, and ensuring seamless...
-
Nurse Care Manager
2 weeks ago
Oakland, California, United States Talent Software Services Full timeJob SummaryTalent Software Services is seeking a skilled Nurse Care Manager to join our team. As a key member of our Patient Care Services Department, you will be responsible for managing the overall nursing care provided to patients, ensuring competent, compassionate, and cost-effective care from admission to discharge.ResponsibilitiesDevelop and implement...
