RN Care Manager Emergency Room PD Nights

RN Care Manager Emergency Room PD Nights

The purpose of the Case Manager position supports the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates the functions of utilization management, care progression and care transition.

The Case Manager is accountable for a designated patient caseload and plans effectively to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include:

• Facilitation of precertification and payor authorization processes
• Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement
• Application of process improvement methodologies in evaluating outcomes of care
• Coordinating communication with physicians.

The role reflects appropriate knowledge of RN scope of practice, current state requirements, CMS Conditions of Participation, EMTALA, The Patient Bill of Rights, AB1203 and other Federal or State regulatory agency requirements specific to Utilization Review and Discharge Planning. The Care Manager partners with the medical staff, utilizes scientific evidence for best practices, and relevant data to manage the care of the patient over the continuum of their hospitalization. These activities include admission, continued, extended and discharge reviews in all reimbursement categories to determine medical necessity, assure high quality of care and efficient utilization of available healthcare resources, facilities and services. This position requires the full understanding and active participation in fulfilling the Mission of Martin Luther King, Jr. Community Hospital. It is expected that the employee will demonstrate behavior consistent with the Core Values. The employee shall support Martin Luther King, Jr. Community Hospital's strategic plan and the goals and direction of the quality and performance improvement process activities.

Essential duties and responsibilities include:

• Assessment: Completes a comprehensive assessment to identify opportunities for intervention that are appropriate and realistic for the patient/family's psycho-social, cultural, spiritual, and physical plan of care.
• Planning: Demonstrates an understanding of medical necessity and intensity of service, and incorporates payer requirements into the development of a safe, effective, and timely discharge plan.
• Implementation: Coordinates the progression of care to ensure that the ongoing needs of the patient and family are adequately addressed.
• Evaluation: Develops and evaluates case management plans and protocols in collaboration with the interdisciplinary team.
• Communication/Collaboration: Serves as a liaison between members of the interdisciplinary care team, community providers, payers, and patient/family to ensure safe and effective plans and smooth transitions between internal and external levels of care.
• Professionalism: Within the nursing scope of practice, the care manager continuously assesses self-knowledge and competencies to assure job performance.

Position requirements include:

• Bachelor of Science degree in nursing preferred
• Minimum of one (1) to three (3) years of hospital or related experience required. Internals with at least 18 months acute care case management/coordination experience will be considered in lieu of nursing clinical experience.
• Able to navigate and connect successfully with outside provider networks (Health Plans, IPA's, and FQHC's).
• Bilingual language skills preferred (Spanish) Basic computer skills
• Current California Nursing license
• Current Basic Life Support (BLS)
• Certification in Case Management preferred.
• ED Care Managers: Must complete annual Workplace Violence Prevention Program/Certificate, per hospital policy, during initial training/orientation but not to exceed 90 days from hire/transfer.