RN Inpatient Acute Case Management

4 weeks ago

Bakersfield, United States Heritage Provider Network Full time
Job Description

Under the direction of the Vice President Hospital Based Services Inpatient / Outpatient, this position is responsible to Provide guidance and coordination for Utilization Review Department. Evaluate inpatient medical records using criteria and facilitate discharge plans and needs. The RN or LVN Inpatient Acute Case Manager will interact with other departments, clinic personnel, and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.

1.1Accepts responsibility for assigned patients in the acute and subacute setting.

1.2 Performs initial patient interview to assess, identify, evaluate and plan a safe discharge. Interview to include:

  • Activity level
  • POA or Contact person information
  • Durable Medical Equipment needed or utilized.
  • Social network or barriers to care.
  • Advanced Directives
  • Anticipated discharge needs
  • Medical History
  • Hospital admission diagnosis
  • Education of disease process
  • Concurrent Review with justification of stay.
  • Anticipated discharge plan
1.3 Performs daily concurrent review on assigned patients. Assessment to include:
  • Chart review for evaluation of appropriate level of care.
  • Identify barriers to treatment and report to V.P.HBS.
  • Proactively reach out to expedite procedures or consults.
  • Facilitate patients’ progress through the continuum of care.
  • Report aberrant bed days per policy.
1.4 Maintains communication with attending physician throughout the hospital stay to discuss procedures consults patientprogress, barriers to care and patient status regarding any utilization of hospital services of problems noted.

1.5 Work with attending physician to identify discharge needs.

1.6 Facilitate discharge plans.

1.7 Perform daily utilization review with Medical Director and V.P. HBS or designee regarding status of all hospitalizedpatients.

1.8 Be proactive with treatment options.

1.9 Aggressively assist in information gathering to allow for continuity of care.

1.10 Assist with patient problems as assigned by the Medical Director and V.P HBS.

1.11 Proactively gathers information to specialty and attending pertinent information to support transitions in levels of care.

1.12 Educates patients and caregivers regarding Advance Directives.

1.13 Strive for positive and professional relationships with providers, patients and families.

1.14 Ensure a smooth transition of care after discharge.

1.15 Initiate/participate in Code Red, Code White, and Code Blue situation.

1.16 Requires effective communication with involved health care provider.

1.17 Requires familiarity with the clinical structure of BFMC and the health care services with which it contracts.

1.18 Act in a proactive manner to the benefit of the patient regardless of setting.

1.19 Communicate with attending physician regarding any utilization of hospital services or problems noted.

1.20 Establish and maintain a functional familiarity with all contract services with which we deal.

1.21 Must evaluate each patient’s support system. This may include immediate family, extended family and close friends.

1.22 Understand patient benefits and help establish expectations for service within those benefit limits.

1.23 Assist in establishing decisions with regard to resuscitation, durable power of attorney, and efforts to obtain Medi-Cal

benefits when appropriate.

1.24 Coordinate Utilization Review activities and ensure smooth operation by providing guidance to Utilization Review

Discharge Planner.

1.25 To assist Bakersfield Family Medical Center SNF Case Manager with Utilization Review and Discharge Planning.

1.26 Oversee SNF patients and conduct weekly team meeting with SNF staff and Bakersfield Family Medical Center SNF

Case Manager to review patients’ progress and determined continued skilled need.

1.27 Be available and willing to fill in as needed,

1.28 Assure responsibilities of Directors position as needed i.e., PTO.

1.29 Assure On-Call status as scheduled 24/day.

1.30 Culture and Linguistics training.

Requirements
  • Graduate from an accredited Registered Nursing program or Licensed Vocational Nursing
  • Current California RN or LVN license.
  • Current BLS certification.
  • Minimum of two years clinical nursing experience.
  • Minimum of one year utilization review experience.
  • Ability to utilize electronic mail effectively.
  • Supervisory experience preferred.


The pay range for this position at commencement of employment is expected to be between $53.77 and $63.26 however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

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