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RN Manager of Case Mgmt.
4 months ago
Position Details
The Manager coordinates the care of the patients across the continuum of care. Responsible for addressing CDI, utilization management, social services, and discharge planning activities in order to optimize patient outcomes within appropriate time frames. Facilitates the proper use of resources. Assists the director in the development and coordination of all programs in Case Management. Maintains compliance with regulatory standards within the scope of Case Management Dept. Responsibilities include: Outcomes Management, Utilization Management, Reporting/Data Analysis and Staff Management.
ESSENTIAL FUNCTIONS:
- Assists with the coordination of staff orientations and training programs.
- Documents and assesses effectiveness of staff training and reports findings to the Director of CM.
- Establishes and presents educational programs designed to educate and inform members of the Medical Staff and Nursing personnel on CDI , Utilization Review (UR), Discharge Planning (DCP), Social Service (SS) and other Case Management initiatives.
- Monitors individual staff caseloads and beneficiary treatment plans to ensure effective delivery of care, productivity and timeliness within scope of practice in compliance with Department protocols.
- Develops staff performance evaluations in collaboration with Director of Case Management.
- Develops Case Management and CDI reports to Monitor Departmental outcomes, trends and issues and submits those reports to the Director of Case Management.
- Collaborates with medical providers, the Director and Nursing Leadership, on program interpretation and guidance.
- Revises operational processes, policies and procedures to ensure overall program effectiveness...
- Participate in weekly staffing meetings with Clinicians, Case Managers, Case Coordinator, and other PMHD staff.
- Conducts weekly meetings with the HIM coders to review and resolve differences in coding interpretations prior to the billing period.
- Meets with the Director of Case management regularly to update the Director of CM on all Case Management Activities.
- Performs other duties and assumes other responsibilities as assigned by the Director of Case Management including a case load as needed by the department (as assigned).
- Engages Medical staff in collaboration regarding patient status (Obs vs Inpatient)
- Attends safety, ED, and Bed Huddles.
- Prepares agenda, takes minutes of Dept Meetings
- Conducts and facilitates Multidisciplinary Rounding (MDR).
- Provides review support pertaining to status and levels of care using MCG / InterQual.
OTHER RESPONSIBILITIES:
Other duties as assigned from time to time.
SUPERVISORY RESPONSIBILITIES:
Assumes responsibility for direct supervision of the case management Department in absence of the Director.
EDUCATION, KNOWLEDGE, SKILLS, ABILITIES, AND EXPERIENCE:
- Bachelor’s degree in nursing, required.
- Experie4nce and proficient in MCG / InterQual.
- Experience in EMR; Cerner, Epic, MedTech.
- Proficient in Microsoft Suite
- Minimum 3 -5 years general acute care hospital case management experience required.
- Minimum of three (3) years administrative/supervisory case management experience in an acute care environment, required.
LICENSES AND CERTIFICATIONS:
- Current, unencumbered, active license to practice as a Registered Professional Nurse in the state of California required.
- Certified Case Manager (CCM) required (achieve with 1 year of employment).
AGE OF POPULATION SERVED:
Newborn Infant/Pediatric Adolescent Adult Geriatric All No Patient Care X
