About this role
Salary Range: $90.16 - $121.74 + applicable differentials
The Registered Nurse Case Manager funct i ons as a membe r of t h e m ul t i discip l inary health care team to facilitate patient movement through the continuum of care and back i nto the community . The case manager supports the physician and i nterdisciplinary team in facilitat i ng patient care with t he under l y i ng objective of enhancing the quality of the clin i ca l outcomes and pat i ent satisfaction, wh il e managing the cost of care and providing timely and accurate informa t i on to payors . As part of the team , the case manager makes decisions regarding utilization managemen t and a l ternative t r eatment which reflects cost effect i ve n ess. Prov i des interface with internal departments an d externa l departments a n d agenc i es. The ro l e integrates and coordinates uti l ization management, care facilitation and discharge planning funct i ons. In addition , the case manager helps d r ive c h ange by identifying areas where performance improvement i s n eeded. In addition to performing t h e essentia l func t ions listed below , may also be ass i gned other dut i es 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.