RN Case Manager
2 months ago
Job Summary:
Works collaboratively with an MD to coordinate and screen for the
appropriateness of admissions and Continued stays. Makes recommendations to the
physicians for alternate levels of care when the patient does not meet the
medical necessity for Inpatient hospitalization. Interacts with the family,
patient and other disciplines to coordinate a safe and acceptable discharge
plan. Functions as an indirect caregiver, patient advocate and manages patients
in the most cost effective way without compromising quality. Transfers stable
non-members to planned Health care facilities. Responsible for complying with
AB 1203, Post Stabilization notification. Complies with other duties as
described. Must be able to work collaboratively with the Multidisciplinary
team, multitask and in a fast pace environment.
Essential Responsibilities:
· Plans, develops, assesses and evaluates care provided to members.
· Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use.
· Recommends alternative levels of care and ensures compliance with federal, state and local requirements.
· Assesses high risk patients in need of post-hospital care planning.
· Develops and coordinates the implementation of a discharge plan to meet patients identified needs.
· Communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies.
· Reviews, monitors, evaluates and coordinates the patients hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
· Participates in the Bed Huddles and carries out recommendations congruent with the patients needs.
· Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families.
· Conducts daily clinical reviews for utilization/quality management activities based on
guidelines/standards for patients in a variety of settings, including
outpatient, emergency room, inpatient and non-KFH facilities.
· Acts as a liaison between in-patient facility and referral facilities/agencies and
provides case management to patients referred.
· Refers patients to community resources to meet post hospital needs.
· Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation.
· Adheres to internal and external regulatory and accreditation requirements and
compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC,NCQA and DOL.
· Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources.
· Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
· Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities.
· Reviews, analyses and identifies utilization patterns and trends, problems or inappropriate utilization of resources and participates in the collection and
analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.
· Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed.
· Participates in committees, teams or other work projects/duties as assigned.
Qualifications
Experience
· At least Two (2) years combined RN experience in an acute care setting or case management
required.
Education
· Completion of an accredited RN training program that allows graduates to take RN license
exam.
License, Certification, Registration
· Registered Nurse License (California)
· Basic Life Support
Additional Requirements:
· Demonstrated ability to utilize/apply the general and specialized principles, practices,
techniques and methods of Utilization review/management, discharge planning or
case management.
· Working knowledge of regulatory requirements and accreditation standards (TJC,
Medicare, Medi-Cal, etc.).
· Demonstrated ability to utilize written and verbal communication, interpersonal, critical
thinking and problem-solving skills.
· Demonstrated ability in planning, organizing, conflict resolution and negotiating skills.
· Computer literacy skills required.
Work Environment
This position operates in a professional healthcare setting with a Monday to Friday schedule, starting at 08:00 and ending at 16:30. The work environment includes collaboration with a multidisciplinary team, utilization of HealthConnect or EPIC systems, and adherence to hospital policies and procedures. The role requires compliance with regulatory standards and effective communication with patients, families, and healthcare providers.
Pay and Benefits
The pay range for this position is $65.00 - $75.00
• Medical, dental & vision• Critical Illness, Accident, and Hospital• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available• Life Insurance (Voluntary Life & AD&D for the employee and dependents)• Short and long-term disability• Health Spending Account (HSA)• Transportation benefits• Employee Assistance Program• Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully onsite position in San Diego,CA.
Application Deadline
This position will be accepting applications until Dec 16, 2024.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
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Hiring diverse talent
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Maintaining an inclusive environment through persistent self-reflection
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Building a culture of care, engagement, and recognition with clear outcomes
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Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.
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