RN - Case Manager

Details

Client Name
Dignity Health - Mercy San Juan Medical Center

Job Type
Travel

Offering
Nursing

Profession
RN

Specialty
Case Manager

Job ID
19024021

Job Title
RN - Case Manager

Weekly Pay
$3328.0


Shift Details

Shift
Days 5x8

Scheduled Hours
40


Job Order Details

Start Date
10/13/2026

End Date
01/26/2027

Duration
15 Week(s)


Job Description
Job Summary: Utilizes clinical expertise, discretion, and independent judgment in assessing/reassessing, facilitating care coordination, utilization management, and patient advocacy. Responsible for assuring medical appropriateness criteria are met for status and level of care. Job Responsibilities • Reviews & analyzes information relative to admission in accordance with Centura policy and documents assessment using case management software and/or other clinical information system. • Assesses patient's physical, psychosocial, cultural and spiritual needs through observation, interview, review of records and interfacing with patient, physician and interdisciplinary team and caregivers to assist patient/family in making decisions toward next level of care. • Reviews & analyzes information relative to utilization management when applicable. • Facilitates discharge planning using case management software, working with patients, families and treatment team making any needed referrals/arrangements and documenting actions. • Participates in the Performance Improvement process through concurrent chart review and participation on clinical effectiveness teams. • Documents CM actions taken in EMR. • Confirms treatment goals and anticipated plan of care through discussions with treatment team/review of documentation. • Utilizes tools such as guidelines, criteria, or clinical pathways to assist in facilitating plan of care and appropriateness. • Communicates treatment goals or best practices to treatment team including physician using established criteria/guidelines. • Assess, coordinates and evaluates use of resources and services relative to plan of care and discusses variances on an as-needed basis with treatment team. • Communicates modifications in plan of care to treatment team and any needs for further documentation. • Facilitates family conference meetings on an as-needed basis and documents outcome. • Participates and/or leads interdisciplinary rounds to facilitate plan of care and discharge. • Reviews variance in Plan of Care with CM Director/Manager as needed. • Interfaces closely with Social Worker, Homecare Coordinator, Ambulatory Care Case Manager, Disease Manager, and Utilization Reviewer to ensure seamless and timely delivery of services and avoid unnecessary delays in discharge. • Maintains updated referral resource lists. • Identifies when variances occur in anticipated plan of care, tracks for process improvement, and refers to CMO or PA or Third Party Reviewer for peer review as needed. • Tracks avoidable days using case management software. • Able to identify and apply evidence based criteria/regulatory guidelines for accuracy in establishing appropriate patient status and level of care. Applies medically necessary validation and may enlist physician advisor and/or Third Party Reviewer. • Involved with identifying LOS and projected discharge date early in admission and communicate this May 06, 2021 Version: 1 Page 3 of 6 to the care team. • Works with third party payers to satisfy utilization review requests and obtain approval of stays. • Participates in providing information on outliers for length of stay and recommending proactive solutions. • Participates in denial management with CM Manager/Director with clinical information for denial reversals. • Performs utilization review in accordance with UM Plan to include concurrent/retro reviews and verify admission/bed status. • Proactive management of factors influencing length of stay using critical thinking skills minimizing variance days. • Proactive monitoring of appropriate patient status with interaction with physician for to assure correct order early in admission.
Skills: 1 year of nursing or case management experience Experience working with EMR, preferred Working knowledge of regulatory requirements and accreditation standards, preferred Float Requirements: -Floating may be required to any Centura location within sixty (60) miles of the original assignment location or Centura-identified "float zone". -Float assignments may include duties outside of original assignment job requirements (including skill set) in accordance with Centura policy.
Education: Associate Degree in Nursing is required. Bachelor Degree in Nursing is preferred. State RN license or RN license from a participating state in the NLC American Heart Association Basic Life Support (BLS)


Client Details

Address
6501 Coyle Ave

City
Carmichael

State
CA

Zip Code
95608