RN Inpatient Case Management

2 weeks ago

Bakersfield, United States Heritage Provider Network Full time
Job Description

Rotational Schedule: 4 10 hours shifts.

Under the direction of the Senior VP of Medical Management, responsible for review, provide guidance and coordination for the Acute units of the Utilization Review Department. Evaluation of inpatient medical records using criteria and facilitation of discharge plans and needs. The Acute CM 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.

  • Will cover Acute care patients on a rotational schedule based on the needs of the department.
  • Accepts responsibility for assigned patients in the acute setting.
  • 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.
    • Obtain baseline functional status of all patients.
    • Primary Caregiver at home.
    • Social network or barriers to care.
    • Advanced Directives (POA).
    • Anticipated discharge needs
    • Medical History.
    • Hospital admission diagnosis.
    • Education of disease process.
    • Anticipated discharge plan.
    • Verify consulting physicians are contracted.
  • Performs daily concurrent review on assigned patients. Assessment to include:
    • Chart review for evaluation of appropriate level of care and document on tracking sheet including procedures and specialty consults.
    • Identify barriers to treatment and/or delays report to Sr. VP of Medical Management.
    • Proactively reach out to expedite procedures or consults.
    • Facilitate patients’ progress through the continuum of care.
    • Report aberrant bed days per policy.
    • In person or telephonic sign-out of all hospitalized patients must be conducted daily with Sr. VP of Medical Management or designee.
    • Electronic sign-out on all patients must be submitted by end of shift each day.
  • Maintains communication with attending physician throughout the hospital stay to discuss procedures consults patient progress, barriers to care and patient status regarding any utilization of hospital services of problems noted.
  • Work with attending physician to identify discharge needs and identify any barrier to discharge.
  • Facilitate discharge plans.
  • Perform daily utilization review with Medical Director and Sr. V.P. of Medical Management or designee regarding status of all hospitalized patients.
  • Be proactive with treatment options.
  • Aggressively assist in information gathering to allow for continuity of care.
  • Assist with patient problems as assigned by the Medical Director and Sr. VP of Medical Management.
  • Proactively gathers information to specialty and attending pertinent information to support transitions in levels of care.
  • Educates patients and caregivers regarding Advance Directives.
  • Strive for positive and professional relationship with providers, patients and families.
  • Ensure a smooth transition of care after discharge.
  • Initiate/participate in Code Red, Code White, and Code Blue situation.
  • Requires effective communication with involved health care provider
  • Requires familiarity with the clinical structure of BFMC and the contracted health care services.
  • Act in a proactive manner to the benefit of the patient regardless of setting.
  • Communicate with attending physician regarding any utilization of hospital services or problems noted.
  • Establish and maintain a functional familiarity with all contract services with which we deal.
  • Must evaluate each patient’s support system. This may include immediate family, extended family and close friends.
  • Understand patient benefits and help establish expectations for service within those benefit limits.
  • Assist in establishing decisions regard to resuscitation, durable power of attorney, and efforts to obtain Medi-Cal benefits when appropriate.
  • Be available and willing to fill in as needed, case management schedule is subject to change if not yet posted based on the needs of the department.
Requirements
  • Graduate from an accredited Registered Nursing program or Licensed Vocational Nursing program.
  • 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.
  • Must have valid CA Driver's license and current vehicle insurance.


The pay range for this position at commencement of employment is expected to be between $48.60 and $57.18 however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include a sign-on bonus.

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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