Acute Care Case Management Registered Nurse
2 weeks ago
Under the supervision of the Vice President of Hospital-Based Services, this role is tasked with overseeing the Utilization Review Department. The RN or LVN in Acute Care Case Management will evaluate inpatient medical records using established criteria and facilitate discharge planning and requirements. This position requires interaction with various departments, clinic staff, and external providers in a professional and amicable manner to foster positive relationships with both internal and external stakeholders.
Key Responsibilities
1.1 Assume responsibility for assigned patients in both acute and subacute environments.
1.2 Conduct initial patient assessments to identify, evaluate, and plan for safe discharges. This assessment includes:
- Activity levels
- Contact person or Power of Attorney information
- Durable Medical Equipment needs
- Social support networks or barriers to care
- Advanced Directives
- Anticipated discharge requirements
- Medical history
- Hospital admission diagnosis
- Education on disease processes
- Concurrent review with justification for hospital stay
- Anticipated discharge plans
- Chart evaluations for appropriate levels of care
- Identification of treatment barriers to report to the Vice President of Hospital-Based Services
- Proactive outreach to expedite procedures or consultations
- Facilitation of patient progress through the continuum of care
- Reporting of aberrant bed days as per policy
1.5 Collaborate with attending physicians to identify discharge needs.
1.6 Facilitate discharge planning.
1.7 Conduct daily utilization reviews with the Medical Director and Vice President of Hospital-Based Services or their designee regarding the status of all hospitalized patients.
1.8 Be proactive in exploring treatment options.
1.9 Assist in gathering information to ensure continuity of care.
1.10 Address patient issues as assigned by the Medical Director and Vice President of Hospital-Based Services.
1.11 Proactively collect information from specialists and attending physicians to support transitions in care levels.
1.12 Educate patients and caregivers on Advanced Directives.
1.13 Strive to maintain positive and professional relationships with providers, patients, and families.
1.14 Ensure smooth transitions of care post-discharge.
1.15 Participate in emergency situations as required.
1.16 Effective communication with all involved healthcare providers is essential.
1.17 Familiarity with the clinical structure of the organization and the healthcare services it contracts with is necessary.
1.18 Act proactively for the benefit of patients in all settings.
1.19 Communicate with attending physicians regarding any issues related to hospital services.
1.20 Establish and maintain familiarity with all contracted services.
1.21 Evaluate each patient's support system, including immediate and extended family and close friends.
1.22 Understand patient benefits and help set expectations for services within those limits.
1.23 Assist in making decisions regarding resuscitation, durable power of attorney, and Medi-Cal benefits when appropriate.
1.24 Coordinate Utilization Review activities to ensure smooth operations by providing guidance to the Utilization Review Discharge Planner.
1.25 Support the SNF Case Manager with Utilization Review and Discharge Planning.
1.26 Oversee SNF patients and conduct weekly team meetings with SNF staff to review patient progress and determine ongoing skilled needs.
1.27 Be available to fill in as needed.
1.28 Ensure responsibilities of the Director's position are met as necessary.
1.29 Maintain on-call status as scheduled.
1.30 Complete Culture and Linguistics training.
Qualifications
- 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 of clinical nursing experience.
- Minimum of one year of utilization review experience.
- Proficient in the use of electronic mail.
- Supervisory experience is preferred.
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