Case Manager, RN PRN Days
2 weeks ago
JOB SUMMARY
Assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, nursing, patient and significant others who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.
DUTIES AND RESPONSIBILITIES
Essential Job Duties
Responsible for performing assessments on Medicare, Medicaid, Private Pay, Commercial insured and high-risk patients to determine discharge planning needs, always documents assessments. (Interqual criteria review proficiency) Able to communicate with physician regarding Medical necessity of the patient. Assists the physician to facilitate optimal documentation to support level of care. Is knowledgeable of criteria for Medicare, Medicaid, Commercial and private insurance coverage. Communicates daily with admissions personnel regarding admissions and discharges to various units, when applicable. Treats patients and families with respect and dignity. Interacts professionally with patient/family and involves patient/family in the formation of the plan of care if necessary. Is knowledgeable of patient’s financial status, diagnosis and discharge needs. Acts on performance improvement issues identified during CQI meetings. Collaboration with insurance Case Manager to assure clinical information submitted/received. Maintains and respects confidentiality of patient/physician/personnel information Collaborates with the Business Office Manager, insurance verification, Clinical Documentation Specialist and Authorization Coordinator to facilitate obtaining authorizations for appropriate level of care. Actively participates in Utilization Management Committee, CQI, varying team meetings and other meetings as appropriate. Demonstrates an ability to be flexible, organized and function under stressful situations. Maintains a good working relationship both within the department and with other departments. Consults other departments as appropriate to collaborate on patient care and performance improvement activities. Documentation meets current standards and policies.PROFESSIONAL REQUIREMENTS
Adheres to dress code; appearance is neat and clean. Completes annual educational requirements. Maintains regulatory requirements, including all state, federal and JCAHO regulations related to the Imaging Services Department and, as appropriate, to the facility. Maintains and ensures patient confidentiality at all times. Reports to work on time and as scheduled. Wears identification while on duty. Attends annual review and performs departmental in-services. Works at maintaining, a good rapport and a cooperative working relationship with physicians, departments and staff. Represents the organization in a positive and professional manner. Attends committee, CQI and management meetings, as appropriate. Resolves personnel concerns at the departmental level, utilizing the grievance process as required. Ensures compliance with policies and procedures regarding department operations, fire, and safety and infection control. Effectively and consistently communicates administrative directives to personnel and encourages interactive departmental meetings and discussions. Complies with all organizational policies regarding ethical business practices. Attends at least 8 staff meetings annually, is responsible for information presented at monthly staff meetings that he/she is unable to attend.REGULATORY REQUIREMENTS
Current Registered Nurse licensure in State of Texas. Medical Surgical nursing within past 3 -5 years Is a motivated, independent individual who can organize workload so that all functions are completed appropriately Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage. Annual Interqual review/proficiency Experience in providing patient care.LANGUAGE SKILLS
Ability to read and communicate effectively in English. Additional languages preferred.SKILLS
Basic computer knowledge The individual’s responsibilities include the following activities:
a) accurate medical necessity screening and submission for Physician Advisor review,
b) care coordination,
c) transition planning assessment and reassessment,
d) implementation or oversight of implementation of the transition plan,
e) leading and facilitating multi-disciplinary patient care conferences,
f) managing concurrent disputes,
g) making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services,
I) communicating with patients and families about the plan of care,
j) collaborating with physicians, office staff and ancillary departments,
k) leading and facilitating Complex Case Review,
l) assuring patient education is completed to support post-acute needs ,
m) timely complete and concise documentation in Case Management system,
n) maintenance of accurate patient demographic and insurance information,
o) identification and documentation of potentially avoidable days,
p) identification and reporting over and underutilization,
q) and other duties as assigned.
Required: Graduate of an accredited school of nursing
Preferred: Academic degree in nursing (bachelor's or master's)
Required: 2 years of acute hospital patient care experience
Preferred: Acute hospital case management experience
Required: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered.
Preferred: Accredited Case Manager (ACM)
Lift/position up to 25 lbs. Push/pull up to 25 lbs. of force. Frequent sitting. Moderate standing, walking, reaching, stooping, and bending. Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.
-
Case Manager I Fulltime Days
3 weeks ago
Sunnyvale, United States Baylor Scott & White Medical Center - Sunnyvale Full timeBaylor Scott & White Medical Center - Sunnyvale is an acute care hospital serving the communities in and around Sunnyvale, Texas. We strive to make the lives of our patients and their families better at every interaction. Our Team Members live out this passion in their daily roles as we support their career and personal goals. We are located just minutes...
-
Case Manager, Rn Prn Days
2 weeks ago
Sunnyvale, United States Baylor Scott & White Medical Center - Sunnyvale Full time**JOB SUMMARY** Assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, nursing, patient and significant others who have an ongoing...
-
Hospice Rn Case Manager
3 days ago
Sunnyvale, United States Sterling and Landers - Hospice Client Full time_**Full-time rates to $80/hr, $9K signing bonus, 5 weeks of PTO, free medical!**_ **Hospice RN Case Manager** **Sterling and Landers - Partnering with a Hospice Client** **Sunnyvale, CA** If you are a compassionate Hospice RN Case Manager, we welcome you to join our cohesive and caring team of clinicians, part of a fast growing Home Health and Hospice...
-
Case Manager, RN PRN Days
3 weeks ago
Sunnyvale, TX, United States Baylor Scott & White Medical Center - Sunnyvale Full timeThis includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, nursing, patient and significant others who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to...
-
Case Manager-sunnyvale Outreach
3 weeks ago
Sunnyvale, United States HomeFirst Full time**POSITION**:Case Manager, Housing Retention Services **PROGRAM/LOCATION**: Santa Clara County, Boccardo Reception Center **SUPERVISOR**: Program Manager **JOB TYPE**: Full Time, Non-Exempt **COMPENSATION**: $29.77/Hourly **AGENCY SUMMARY**: Established in 1980, with 40+ years of experience, we are the premier Silicon Valley provider of homelessness...
-
Case Manager Ii
3 weeks ago
Sunnyvale, United States MidPen Housing Corporation Full time**WHY MIDPEN** At MidPen, we build communities that change lives. Since 1970, we have been committed to our mission: to provide safe, affordable housing of high quality to those in need; establish stability and opportunity in the lives of residents; and foster diverse communities that allow people from all ethnic, social, and economic backgrounds to live in...
-
GI/Endo Registered Nurse PRN Days
1 week ago
Sunnyvale, United States Tenet Healthcare Full timeBaylor Scott & White Medical Center - Sunnyvale is an acute care hospital serving the communities in and around Sunnyvale, Texas. We strive to make the lives of our patients and their families better at every interaction. Our Team Members live out this passion in their daily roles as we support their career and personal goals. We are located just minutes...
-
Case Manager
3 weeks ago
Sunnyvale, United States Premise Health Full timeHealthcare Without Rival Premise Health is the world's leading direct healthcare provider and one of the largest digital providers in the country, serving over 11 million eligible lives across more than 2,500 of the largest commercial and municipal employers in the U.S. Premise partners with its clients to offer fully connected care – in-person and in the...
-
Respiratory Therapist PRN Days
3 weeks ago
Sunnyvale, United States Tenet Healthcare Full timeBaylor Scott & White Medical Center - Sunnyvale is an acute care hospital serving the communities in and around Sunnyvale, Texas. We strive to make the lives of our patients and their families better at every interaction. Our Team Members live out this passion in their daily roles as we support their career and personal goals. We are located just minutes...
-
Registered Nurse Case Manager
2 months ago
Sunnyvale, United States Pathways Home Health, Hospice and Private Duty Full timeJob DescriptionJob DescriptionFor over 45 years Pathways has been a Bay Area pioneer, leader, and innovator in Hospice, Home Health and Palliative Care. We provide care at home or in settings such as assisted living, a nursing home, or the hospital. We have offices in Sunnyvale, South San Francisco, and Oakland. Patients and their families know us for our...
-
Registered Nurse Case Manager
3 weeks ago
Sunnyvale, United States Pathways Home Health, Hospice and Private Duty Full timeJob DescriptionJob DescriptionFor over 45 years Pathways has been a Bay Area pioneer, leader, and innovator in Hospice, Home Health and Palliative Care. We provide care at home or in settings such as assisted living, a nursing home, or the hospital. We have offices in Sunnyvale, South San Francisco, and Oakland. Patients and their families know us for our...
-
Registered Nurse Case Manager
2 weeks ago
Sunnyvale, United States Pathways Home Health, Hospice and Private Duty Full timeJob DescriptionJob DescriptionFor over 45 years Pathways has been a Bay Area pioneer, leader, and innovator in Hospice, Home Health and Palliative Care. We provide care at home or in settings such as assisted living, a nursing home, or the hospital. We have offices in Sunnyvale, South San Francisco, and Oakland. Patients and their families know us for our...
-
Registered Nurse Case Manager
4 weeks ago
Sunnyvale, United States Pathways Home Health and Hospice Full timeFor over 45 years Pathways has been a Bay Area pioneer, leader, and innovator in Hospice, Home Health and Palliative Care. We provide care at home or in settings such as assisted living, a nursing home, or the hospital. We have offices in Sunnyvale, South San Francisco, and Oakland. Patients and their families know us for our personalized, high-quality care,...
-
Registered Nurse Case Manager
1 month ago
Sunnyvale, United States Pathways Home Health and Hospice Full timeFor over 45 years Pathways has been a Bay Area pioneer, leader, and innovator in Hospice, Home Health and Palliative Care. We provide care at home or in settings such as assisted living, a nursing home, or the hospital. We have offices in Sunnyvale, South San Francisco, and Oakland. Patients and their families know us for our personalized, high-quality care,...
-
Registered Nurse Case Manager
2 weeks ago
Sunnyvale, United States Pathways Home Health and Hospice Full timeFor over 45 years Pathways has been a Bay Area pioneer, leader, and innovator in Hospice, Home Health and Palliative Care. We provide care at home or in settings such as assisted living, a nursing home, or the hospital. We have offices in Sunnyvale, South San Francisco, and Oakland. Patients and their families know us for our personalized, high-quality care,...
-
Local Contract Nurse RN
2 weeks ago
Sunnyvale, United States Therapy Staff EDU Full timeTherapy Staff EDU is seeking a local contract nurse RN School RN for a local contract nursing job in Sunnyvale, California.Job Description & RequirementsSpecialty: School RNDiscipline: RNStart Date: 07/31/2024Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Local ContractAequor, LLC is now hiring a full-time School Nurse RN for the...
-
RN and LPN PRN Flu Vaccination Positions
2 weeks ago
Sunnyvale, United States Ramp Health Full timeReports to: Program/Operations ManagerNote: There will be other opportunities outside of simply providing flu vaccinationsResponsibilities:Perform Biometric testing to include sample collection using finger-stick technique, manual and automatic blood pressure readings, body mass index, body fat, bone density, spirometry, as neededReview results and provides...
-
Lab Assistant Fulltime Days
3 weeks ago
Sunnyvale, United States Baylor Scott & White Medical Center - Sunnyvale Full timeBaylor Scott & White Medical Center - Sunnyvale is an acute care hospital serving the communities in and around Sunnyvale, Texas. We strive to make the lives of our patients and their families better at every interaction. Our Team Members live out this passion in their daily roles as we support their career and personal goals. We are located just minutes...
-
Center Manager
3 weeks ago
Sunnyvale, United States Satellite Healthcare Full timeJob DescriptionSeeking an experienced Dialysis-Experienced RN with leadership experience to join our North Sunnyvale Clinic as a Center Manager.ABOUT THE LOCATION Satellite Healthcare North Sunnyvale is located off of Highway 101 and Highway 237, near Sunnyvale Municipal Golf Course and Moffett Field. The area features many shops, restaurants and hotels....
-
Lab Assistant I Prn Rotating
3 weeks ago
Sunnyvale, United States Baylor Scott & White Medical Center - Sunnyvale Full timeBaylor Scott & White Medical Center - Sunnyvale is an acute care hospital serving the communities in and around Sunnyvale, Texas. We strive to make the lives of our patients and their families better at every interaction. Our Team Members live out this passion in their daily roles as we support their career and personal goals. We are located just minutes...
