RN Inpatient Acute Case Manager
7 days ago
Heritage Provider Network is seeking a skilled RN Inpatient Acute Case Manager to join our team. As a key member of our Utilization Review Department, you will be responsible for providing guidance and coordination for inpatient medical records, evaluating patient needs, and facilitating discharge plans.
Key Responsibilities- Accepts responsibility for assigned patients in the acute and subacute setting, performing initial patient interviews to assess, identify, evaluate, and plan a safe discharge.
- Conducts daily concurrent review on assigned patients, assessing chart reviews for evaluation of appropriate level of care, identifying barriers to treatment, and reporting to V.P.HBS.
- Maintains communication with attending physicians throughout the hospital stay, discussing procedures, consults, patient progress, barriers to care, and patient status regarding any utilization of hospital services or problems noted.
- Works with attending physicians to identify discharge needs, facilitates discharge plans, and performs daily utilization review with Medical Director and V.P. HBS or designee regarding status of all hospitalized patients.
- Be proactive with treatment options, aggressively assist in information gathering to allow for continuity of care, and assist with patient problems as assigned by the Medical Director and V.P HBS.
- Proactively gathers information to specialty and attending pertinent information to support transitions in levels of care, educates patients and caregivers regarding Advance Directives, and strives for positive and professional relationships with providers, patients, and families.
- Ensures a smooth transition of care after discharge, initiates/participates in Code Red, Code White, and Code Blue situations, and requires effective communication with involved healthcare providers.
- Requires familiarity with the clinical structure of BFMC and the healthcare services with which it contracts, acts in a proactive manner to the benefit of the patient regardless of setting, and communicates with attending physicians regarding any utilization of hospital services or problems noted.
- Establishes and maintains a functional familiarity with all contract services with which we deal, evaluates each patient's support system, understands patient benefits, and helps establish expectations for service within those benefit limits.
- Assists in establishing decisions with regard to resuscitation, durable power of attorney, and efforts to obtain Medi-Cal benefits when appropriate, coordinates Utilization Review activities, and ensures smooth operation by providing guidance to Utilization Review Discharge Planner.
- To assist Bakersfield Family Medical Center SNF Case Manager with Utilization Review and Discharge Planning, oversees SNF patients, and conducts weekly team meetings with SNF staff and Bakersfield Family Medical Center SNF Case Manager to review patients' progress and determine continued skilled need.
- Be available and willing to fill in as needed, assures responsibilities of Directors position as needed i.e., PTO, and assures On-Call status as scheduled 24/day.
- 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.
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