RN - Case Manager

Case Manager RN

Case Manager RN needed for 5/8s every other weekend. Responsible for care coordination and care transitions planning throughout the acute care patient experience. Works in collaboration with the physician, utilization manager, medical social worker, and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. The care management process encompasses communication and facilitates care across the continuum through effective resource coordination. The goals of this role include achieving optimal health, access to care, and appropriate utilization of resources while balancing the patients' self-determination. Collaborates with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third-party payers, and review agencies. Address complex clinical and social situations efficiently to avoid unnecessary admissions if assigned to the emergency department.

Job Accountabilities:

• Conduct initial and continued assessments of patients.
• Review initial physician admission care plans and gather additional medical, psychosocial, and financial information from patient/family interviews, medical record assessments, physicians, and other healthcare providers.
• Determine moderate or high risk levels for readmission.
• Conduct screenings for ancillary supportive services needs, including but not limited to palliative care services.
• Supervise and lead the healthcare team in developing comprehensive, cost-effective care coordination plans that meet the clinical needs of patients.
• Identify and refer quality and risk management concerns to appropriate levels for patient safety reporting and trending.
• Direct and oversee case management assistants to determine preferences for post-acute care services.
• Utilization Management: Review medical records to ensure that patients continue to meet level of care requirements and that chart documentation supports LOC determinations and assignments. Collaborate with attending physicians to confirm necessary documentation to support level of care.
• Expedite transition planning for patients who no longer require acute levels of care. Monitor length of stay and outliers requiring additional resources and focus. Collaborate with financial counselors regarding inpatient stay denials. Ensure delivery of Medicare Important Messages within specific time frames of discharge/transition. Actively participate in patient rounds and collaborate with the interdisciplinary team to ensure timely transitions. Document consistently in electronic health records and maintain current knowledge of relevant requirements.
• Care Coordination/Care Transitions: Formulate transition plans after reviewing available care options and obtaining input from patients/families, physicians, health care teams, payers, and community-based support services. Perform, document, and communicate assessment findings to the healthcare team. Proactively identify barriers to care progression and transitions and work with multidisciplinary teams to resolve them timely. Review and modify plans of care and assess the need for follow-up appointments prior to transitions. Ensure necessary paperwork for post-acute transfers complies with state and federal regulatory requirements. Identify patients appropriate for case management interventions and follow prescribed local resources and workflows for patient transfers. Actively participate in ongoing department operations. Identify new systems, processes, protocols, and methods to improve practices. Contribute to the creation of cost-effective practices that ensure the best patient/provider experience. Effectively communicate with colleagues to promote safe transitions. Develop and maintain productive and professional relationships with the healthcare team and community agencies. Relate with tact and respect to all customers without personal judgment. Engage positively in all department operations and provide constructive feedback. Use effective communication skills to resolve issues promptly.

City: Oakland, State: CA