Clinical Case Manager RN

3 weeks ago


Alameda, California, United States Alameda Health System Full time
Job Title: Clinical Case Manager RN

Alameda Health System is seeking a skilled Clinical Case Manager RN to join our team. As a Clinical Case Manager RN, you will be responsible for providing comprehensive case management services to clients identified with complex health conditions and social challenges that are at risk for health status decline.

Key Responsibilities:
  • Understand insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
  • Review all patients in your caseload in areas such as admission criteria for medical necessity and appropriateness of care, continued stay criteria for medical necessity and appropriateness of care, resource management issues, and other issues including concerns involving under/over utilization, avoidable days, and quality issues.
  • Coordinate daily with the interdisciplinary team in transitioning patients throughout their hospital stay, providing discharge planning services, working with patients/families and receiving multi-disciplinary input to develop an appropriate plan enabling patients to go home or facilitate relocation to another setting.
  • Conduct discharge planning assessments in a timely and complete manner, considering the age and cultural or religious influences of the patient/family.
  • Guide patients in understanding the nature of their illness, confer with patients and their families to prepare for their discharge, and provide community resource education and coaching, focusing on individual client self-management principles.
  • Reassess the client's condition when changes occur and revise the care plan as appropriate, coordinate and arrange for needed services with appropriate local resources, and serve as a client advocate to secure services and financial benefits.
  • Encourage patients to develop realistic plans, make direct contact with or refer patients/families to appropriate community resources, maintain knowledge of currently available resources in the community, and serve as a mentor and educator to the organization's healthcare team assisting with care coordination, training, and quality improvement activities.
Requirements:
  • Bachelor's degree in a related field; Master's degree preferred.
  • Minimum one year related experience in acute care facility and/or utilization review training and/or healthcare experience.
  • Varied clinical experience or experience in case management/community health preferred.
  • Valid license to practice as a Registered Nurse in the State of California.
  • BLS - Basic Life Support Certification - issued by AHA-American Heart Association.
  • Public Health Nurse, Case Management, or Home Health certification preferred.

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