RN Inpatient Acute Case Manager

7 days ago

Bakersfield, California, 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 for providing guidance and coordination for the Utilization Review Department. The RN or LVN Inpatient Acute Case Manager will evaluate inpatient medical records using established criteria and facilitate discharge plans and needs. This role requires interaction with other departments, clinic personnel, and outside providers in a professional and friendly manner to create and maintain a positive relationship with internal and external customers.

Key Responsibilities
  1. Accepts responsibility for assigned patients in the acute and subacute setting.
  2. Performs initial patient interview to assess, identify, evaluate, and plan a safe discharge, including 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, and anticipated discharge plan.
  3. Performs daily concurrent review on assigned patients, including chart review for evaluation of appropriate level of care, identification of barriers to treatment and reporting to V.P.HBS, proactive outreach to expedite procedures or consults, facilitation of patients' progress through the continuum of care, and reporting of aberrant bed days per policy.
  4. 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 or problems noted.
  5. Works with attending physician to identify discharge needs.
  6. Facilitates discharge plans.
  7. Performs daily utilization review with Medical Director and V.P. HBS or designee regarding status of all hospitalized patients.
  8. Is proactive with treatment options.
  9. Aggressively assists in information gathering to allow for continuity of care.
  10. Assists with patient problems as assigned by the Medical Director and V.P HBS.
  11. Proactively gathers information to specialty and attending pertinent information to support transitions in levels of care.
  12. Educates patients and caregivers regarding Advance Directives.
  13. Strives for positive and professional relationships with providers, patients, and families.
  14. Ensures a smooth transition of care after discharge.
  15. Initiates/participates in Code Red, Code White, and Code Blue situations.
  16. Requires effective communication with involved healthcare providers.
  17. Requires familiarity with the clinical structure of BFMC and the healthcare services with which it contracts.
  18. Acts in a proactive manner to the benefit of the patient regardless of setting.
  19. Communicates with attending physician regarding any utilization of hospital services or problems noted.
  20. Establishes and maintains a functional familiarity with all contract services with which we deal.
  21. Must evaluate each patient's support system, including immediate family, extended family, and close friends.
  22. Understands patient benefits and helps establish expectations for service within those benefit limits.
  23. Assists in establishing decisions with regard to resuscitation, durable power of attorney, and efforts to obtain Medi-Cal benefits when appropriate.
  24. Coordinates Utilization Review activities and ensures smooth operation by providing guidance to Utilization Review Discharge Planner.
  25. Assists Bakersfield Family Medical Center SNF Case Manager with Utilization Review and Discharge Planning.
  26. Oversees SNF patients and conducts weekly team meeting with SNF staff and Bakersfield Family Medical Center SNF Case Manager to review patients' progress and determine continued skilled need.
  27. Is available and willing to fill in as needed.
  28. Assures responsibilities of Directors position as needed, i.e., PTO.
  29. Assures On-Call status as scheduled 24/day.
  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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