Hospital Registered Nurse Case Manager

Utilization Management:

• Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional

policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.

• Escalates utilization and system problems which have not been resolved at the local level to the next level immediately.

• Monitors the progression of the plan of care and facilitates discussions with the multidisciplinary teams.

• Educates other healthcare team members on utilization and cost containment initiatives.

• Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care.

• Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care).

Discharge Planning:

• Ensures continuity of care through communication in rounds and written documentation, level of care

recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient.

• Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies.

• Performance Improvement: Monitors care processes to provide cost-effective implementation and evaluation of utilization management

and patient care activities, initiatives, and protocols.

• Participates in the development and implementation of guidelines, pre-printed physician orders, care paths, etc. for patient care.

• Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum.

• Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-day stays, DRGs, LOS, etc.

• Participates in the development, implementation, communication, maintenance and monitoring of local UM Workplan initiatives.

• Administrative and Regulatory: Shares accountability with the UM Manager for planning, developing, and managing the department

budget.

• Participates in interviewing, makes hiring recommendations, orients and provides on-going supervision of support staff.

• Provides input into the performance evaluations of team members.

• May plan and control work assignments and special projects of team members.

• Assists in developing, implementing and maintaining utilization management policies and procedures.

• Must have clear and active RN license in CA

• BSN or equivalent education/experience in nursing or health related field

• Acute care case management required within a hospital setting (minimum 1 year within the last 3 years) with references to reflect.

• Previous case management experience and demonstrated experience in utilization management, discharge planning, or transfer coordination

• Knowledge of Nurse Practice Act, The Joint Commission and other federal/state/local regulations

• Current BLS (Basic Life Support) required

Hours for this Position:

40 hours 8:30am to 5pm. Must be flexible with work days.

Advantages of this Opportunity:

• Competitive salary

• Fun and positive work environment

• Weekly direct deposits