About the role
Salary Range: $90.16 - $121.74 + applicable differentials
The Registered Nurse Case Manager functions as a member of the multidisciplinary health care team to facilitate patient movement through the continuum of care and back into the community. The case manager supports the physician and interdisciplinary team in facilitating patient care with the underlying objective of enhancing the quality of the clinical outcomes and patient satisfaction, while managing the cost of care and providing timely and accurate information to payors. As part of the team, the case manager makes decisions regarding utilization management and alternative treatment which reflects cost effectiveness. Provides interface with internal departments and external departments and agencies. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the case manager helps drive change by identifying areas where performance improvement is needed. In addition to performing the essential functions listed below, may also be assigned other duties as required.
Qualifications:
- California Registered Nurse License and BLS Certification. - Bachelor of Science in Nursing, required. - Two years acute care experience as a Registered Nurse, preferred. - One-year recent experience in Case Management, preferred. - Case Management Certification, preferred. - Current knowledge of reimbursement requirements, level of care, and clinical criteria. - Basic computer skills required. - Demonstrates effective interpersonal and communication skills. - Demonstrates flexibility via an ability to adapt to changing priorities. - Demonstrates good customer relations. - Ability to prioritize assignments and effective time-management skills. - Must be detail oriented, flexible, and committed to patient advocacy. - Demonstrates skills in planning, organizing, and managing. - Excellent verbal and written communication skills required. - Knowledge of basic computer software programs.
Regulatory/Compliance:
- Demonstrates an understanding of legal and regulatory issues (i/e., HIPPA, EMTALA, The Joint Commission, Centers for Medicare and Medicaid Services (CMS) impacting the care delivery and reimbursement process. - Demonstrates understanding of the CMS Conditions of Participation - Practices within the scope of the California Nurse Practice Act (Section 2725) in all aspects of patient care, promoting safe practice in order to reduce risk. - Adheres to hospital, divisional and unit-based policies and procedures.
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