Job Abstract

The RN Case Manager is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience. The RN Case Manager works in collaboration with the Physician, Medical Social Worker and bedside RN to assure the timely movement of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. Oversees the management of acute patient populations across the care continuum with the primary focus to p... more details

Organization:

CPMC-California Pacific Med Center Van Ness

Position Overview:

The RN Case Manager is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience. The RN Case Manager works in collaboration with the Physician, Medical Social Worker and bedside RN to assure the timely movement of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. Oversees the management of acute patient populations across the care continuum with the primary focus to provide coordinated, timely and integrated care. The RN Case Manager reports to either the Supervisor or Manager or Director of Care Coordination in each facility. The RN Case Manager has frequent contact with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources.

Job Description:

EDUCATION

• Equivalent experience will be accepted in lieu of the required degree or diploma.

• Bachelor's: BS in one of following: Nursing or Health Administration.

• Master's: Master in nursing, case management or related field.

CERTIFICATION & LICENSURE

• RN-Registered Nurse of California (required)

• CCM-Certified Case Manager (preferred)

PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN:

• Minimum of three (3) years in acute medical/surgical/ED/ or critical care nursing area required. Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED/ or critical care nursing area may be considered for employment at directors discretion.

• Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED/ or critical care nursing area may be considered for employment at directors discretion.

• Previous Case Management experience preferred.

• Experience utilizing electronic InteQrual or other standardized criteria strongly preferred.

• Experience with clinical assessment for patient with complex medical, emotional and social needs.

• Experience using an electronic medical record system

• Experience and knowledge with MIDAS preferred

SKILLS AND KNOWLEDGE

• Excellent interpersonal communication and negotiation skills.

• A broad knowledge base of health care delivery and case management within a managed care environment.

• Comprehensive knowledge of Utilization Review, levels of care, and observation status.

• Some awareness of healthcare reimbursement systems: HMO, PPO, PPS,CMS preferred.

• Post-acute levels of care such as Home Health, Hospice, AIM, and Palliative Care. SNF, LTAC, B&C, Sub-acute, Acute rehab.

• General Knowledge of coding and DRG assignment process preferred.

• Must be able to effectively communicate with and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.

• Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.

• Demonstrates commitment to service excellence in all patients, family and employee interactions and in performing all job responsibilities.

• Functions in a manner to promote quality patient care and assure a positive patient experience.

• Excellent verbal and written communication skills.

• Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.

• Intermediate computer skills.

• Ability to promote teamwork and to effectively function in teams.

• Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.

Job Shift:

Days

Schedule:

Per Diem/Casual

Shift Hours:

8

Days of the Week:

Variable

Weekend Requirements:

Rotating Weekends

Benefits:

No

Unions:

Yes

Position Status:

Non-Exempt

Weekly Hours:

0

Employee Status:

Per Diem/Casual

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $77.30 to $104.61 / hour

Qualified applicants with arrest and conviction records will be considered for employment. Applicants for specific positions are still required to disclose certain convictions during the application process, and those convictions may also be considered in determining eligibility for employment in accordance with applicable law.

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