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LVN/RN Inpatient Case Management SNF
3 months ago
Under the direction of the Senior VP of Medical Management, position is responsible to review, provide guidance and coordination for the SNF units of the Utilization Review Department. Evaluation of inpatient medical records using criteria and facilitation of discharge plans and needs. The SNF CM Nurse 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.
1.1 Will cover Skilled Nursing facility patients.
1.2 Accepts responsibility for assigned patients in the subacute setting.
1.3 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
- Social network or barriers to care.
- Advanced Directives. (POA)
- Primary Caregiver at home
- Anticipated discharge needs
- Medical History
- Hospital admission diagnosis
- Education of disease process
- Anticipated discharge plan
- Verify consulting physicians are contracted
- Chart review for evaluation of appropriate level of care and document on tracking sheet including procedures and specialty consultants.
- 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.
1.6 Work with attending physician to identify discharge needs and identify any barrier to discharge.
1.7 Facilitate discharge plans.
1.8 Perform daily utilization review with Medical Director and Sr. VP of Medical Management or designee regarding status of all hospitalized patients.
1.9 Be proactive with treatment options.
1.10 Aggressively assist in information gathering to allow for continuity of care.
1.11 Assist with patient problems as assigned by the Medical Director and Sr. VP of Medical Management.
1.12 Proactively gathers information to specialty and attending pertinent information to support transitions in levels of care.
1.13 Educates patients and caregivers regarding Advance Directives.
1.14 Strive for positive and professional relationship with providers, patients and families.
1.15 Ensure a smooth transition of care after discharge.
1.16 Initiate/participate in Code Red, Code White, and Code Blue situation.
1.17 Requires effective communication with involved health care provider.
1.18 Requires familiarity with the clinical structure of BFMG and the contracted health care services.
1.19 Act in a proactive manner to the benefit of the patient regardless of setting.
1.20 Communicate with attending physician regarding any utilization of hospital services or problems noted.
1.21 Establish and maintain a functional familiarity with all contract services with which we deal.
1.22 Must evaluate each patient's support system. This may include immediate family, extended family and close friends.
1.23 Understand patient benefits and help establish expectations for service within those benefit limits.
1.24 Assist in establishing decisions regard to resuscitation, durable power of attorney, and efforts to obtain Medi-Cal benefits when appropriate.
1.25 Oversee SNF patients and conduct weekly team meetings with SNF staff and Bakersfield Family Medical Center Skilled Nursing Provider to review patients' progress and determined continued skilled need.
1.26 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
- Current California RN or LVN
- Current BLS
- Minimum of two years clinical nursing experience
- Minimum of one-year utilization review experience
- Ability to utilize electronic mail
- Supervisory experience
The pay range for this position at commencement of employment is expected to be between $29.33 and $34.50 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.
